Prognostic Accuracy of SOFA, qSOFA, and SIRS for Mortality Among Emergency Department Patients with Infections

OBJECTIVE: This study aimed to determine the prognostic accuracy of SOFA in comparison to quick-SOFA (qSOFA) and systemic inflammatory response syndrome (SIRS) in predicting 28-day mortality in the emergency department (ED) patients with infections. METHODS: A secondary analysis of data from a prospective study of adult patients with documented or suspected infections admitted to an ED in Denmark from Oct-2017 to Mar-2018. The SOFA scores were calculated after adjustment for chronic diseases. The prognostic accuracy was assessed by analysis of sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). RESULTS: A total of 2045 patients with a median age of 73.2 (IQR: 60.9–82.1) years were included. The overall 28-day mortality was 7.7%. In patients meeting a SOFA score ≥2, qSOFA score ≥2, and SIRS criteria ≥2 the 28-day mortality was 13.6% (11.2–16.3), 17.8% (12.4–24.3) and 8.3% (6.7–10.2), respectively. SOFA ≥2 had a sensitivity of 61.4% (53.3–69.0) and specificity of 67.3% (65.1–69.4), qSOFA ≥2 had a sensitivity of 19.6% (13.7–26.7) and specificity of 92.4% (91.1–93.6), and SIRS ≥2 had a sensitivity of 52.5% (44.4–60.5) and specificity of 51.5% (49.2–53.7). The AUROC for SOFA compared to SIRS was: 0.68 vs 0.52; p<0.001 and compared to qSOFA: 0.68 vs 0.63; p=0.018. CONCLUSION: A SOFA score of at least two had better prognostic accuracy for 28-day mortality than SIRS and qSOFA. However, the overall accuracy of SOFA was poor for the prediction of 28-day mortality.