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Sepsis Scoring Calculator: Assessing Organ Dysfunction with the qSOFA (quick SOFA) Score

qSOFA Score

The SOFA (Sequential Organ Failure Assessment) and qSOFA (Quick Sequential or Sepsis Related Organ Failure Assessment) scores are widely used in critical care medicine to assess the severity of organ dysfunction in patients with suspected or confirmed infections. These scores help clinicians identify patients who may be at a higher risk of developing sepsis or septic shock.

SOFA (Sequential Organ Failure Assessment): The SOFA score evaluates the function of six organ systems, which are scored based on the degree of dysfunction. The six organ systems assessed in the SOFA score are:
- Respiratory system (PaO2/FiO2 ratio or arterial oxygen tension/fractional inspired oxygen)
- The Blood (by checking platelet count or administration of platelet transfusion)
- Liver (bilirubin level)
- Cardiovascular system (mean arterial pressure or vasopressor use)
- Central nervous system (Glasgow Coma Scale score)
- Renal system (creatinine level or urine output)
The score ranges from 0 to 4 for each organ system, with higher scores indicating more severe dysfunction. The total SOFA score is calculated by summing up the individual scores for each organ system, with a maximum score of 24. A higher SOFA score indicates a greater risk of mortality and a higher degree of organ dysfunction.
qSOFA (Quick Sequential Organ Failure Assessment): The qSOFA score is a simplified version of the SOFA score and is designed to quickly identify patients who may be at a higher risk of poor outcomes due to infection. It consists of three criteria, and a patient is considered to be at risk if they meet two or more of the following criteria:
- Altered mental status (Glasgow Coma Scale score < 15)
- Systolic blood pressure ≤ 100 mmHg
- Respiratory rate ≥ 22 breaths per minute
The qSOFA score is easier and quicker to calculate than the full SOFA score, making it a useful tool for initial risk stratification in patients with suspected infection. It helps clinicians decide whether further investigation and management for potential sepsis or septic shock are necessary.

Both the SOFA and qSOFA scores are valuable tools in assessing the severity of organ dysfunction and identifying patients who require closer monitoring or more aggressive interventions in the context of infections. However, it's important to note that these scores should be used in conjunction with clinical judgment, and further evaluation may be necessary to confirm the presence of sepsis or septic shock.

Last update: 22 Jun 2023 02:30

Evaluating the Role of qSOFA in estimating patient outcomes

Study 1: A high qSOFA score is not significantly associated with mortality, as qSOFA-negative patients were found to have higher rates of immunosuppression and hematologic malignancies, diseases that may alter the immune response and the validity of the qSOFA score. As a result, qSOFA-negative patients had a similar mortality rate (23.1%) to qSOFA-positive patients (30.2%). ^[1]

Study 2: Another study notes that qSOFA scores of 0, 1, and 2 were not associated with increased ICU mortality rates (odds ratio [OR] of 1.24), while patients with a qSOFA score of 3 had a significantly higher mortality (OR of 2.82). HIV-positive septic patients with a positive qSOFA score had an even higher mortality (OR of 1.33). For patients without infection, both a score of 2 and a score of 3 were significantly associated with an increased odds of in-ICU mortality (OR 6.26). It is noteworthy that even in patients without infection and with a high qSOFA score, mortality was still lower than for septic patients. These results suggest that the qSOFA score may provide prognostic data for non-septic ICU patients as well. ^[2]

Meta-analysis: A 2017 meta-analysis showed that qSOFA doesn't have a high enough sensitivity for diagnosing organ dysfunction. It was neither sensitive enough to provide early risk assessment to help decide if patients would need transfer to the ICU. ^[3]^,^[6] In one analyzed study, qSOFA and SIRS provided similar discrimination for organ dysfunction. ^[4]
The authors note that one downside of the Sepsis-3 definition is the poor sensitivity of the qSOFA scoring system, which makes it not very useful for early sepsis detection. The authors concluded that the SOFA score was superior in predicting hospital mortality, and the SIRS criteria had higher prognostic accuracy for in-hospital mortality than the qSOFA score. However, results from another study found that qSOFA had the greatest prognostic accuracy among the other scores. ^[5]^,^[6]

In conclusion, while the SOFA and qSOFA scores have the ability to identify patients who may have poor outcomes, they lack sensitivity for identifying sepsis patients, and additional laboratory results (such as the new presepsin marker, CRP, and other acute phase reactants) and clinical data may be required.

References

1. Mortality and detailed characteristics of pre-ICU qSOFA-negative patients with suspected sepsis: an observational study; Izumi Nakayama, Junichi Izawa et al.; Annals of Intensive Care, 8, 1, 12 2018

2. qSOFA as a predictor of ICU outcomes in a resource-limited setting in KwaZulu-Natal Province, South Africa; S. M. Savarimuthu, C. Cairns et al.; Southern African Journal of Critical Care, 36, 2, 2020

3. Validation of the new Sepsis-3 definitions: proposal for improvement in early risk identification; E. J. Giamarellos-Bourboulis, T. Tsaganos et al.; Clinical Microbiology and Infection, 23, 2, 2 2017

4. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit; Eamon P. Raith, Andrew A. Udy et al.; JAMA, 317, 3, 1 2017

5. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department; Yonathan Freund, Najla Lemachatti et al.; JAMA, 317, 3, 1 2017

6. SIRS, qSOFA and new sepsis definition; Paul E. Marik, Abdalsamih M. Taeb; Journal of Thoracic Disease, 9, 4, 4 2017

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Lesson authors: Dr. Mironescu Olivier, Dr. Huțuleac Oana-Mihaela

Published on: 22 Jun 2023 02:30

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The SOFA (Sequential Organ Failure Assessment) and qSOFA (Quick Sequential or Sepsis Related Organ Failure Assessment) scores are widely used in critical care medicine to assess the severity of organ dysfunction in patients with suspected or confirmed infections. These scores help clinicians identify patients who may be at a higher risk of developing sepsis or septic shock.

SOFA (Sequential Organ Failure Assessment): The SOFA score evaluates the function of six organ systems, which are scored based on the degree of dysfunction. The six organ systems assessed in the SOFA score are:
- Respiratory system (PaO2/FiO2 ratio or arterial oxygen tension/fractional inspired oxygen)
- The Blood (by checking platelet count or administration of platelet transfusion)
- Liver (bilirubin level)
- Cardiovascular system (mean arterial pressure or vasopressor use)
- Central nervous system (Glasgow Coma Scale score)
- Renal system (creatinine level or urine output)
The score ranges from 0 to 4 for each organ system, with higher scores indicating more severe dysfunction. The total SOFA score is calculated by summing up the individual scores for each organ system, with a maximum score of 24. A higher SOFA score indicates a greater risk of mortality and a higher degree of organ dysfunction.
qSOFA (Quick Sequential Organ Failure Assessment): The qSOFA score is a simplified version of the SOFA score and is designed to quickly identify patients who may be at a higher risk of poor outcomes due to infection. It consists of three criteria, and a patient is considered to be at risk if they meet two or more of the following criteria:
- Altered mental status (Glasgow Coma Scale score < 15)
- Systolic blood pressure ≤ 100 mmHg
- Respiratory rate ≥ 22 breaths per minute
The qSOFA score is easier and quicker to calculate than the full SOFA score, making it a useful tool for initial risk stratification in patients with suspected infection. It helps clinicians decide whether further investigation and management for potential sepsis or septic shock are necessary.

Both the SOFA and qSOFA scores are valuable tools in assessing the severity of organ dysfunction and identifying patients who require closer monitoring or more aggressive interventions in the context of infections. However, it's important to note that these scores should be used in conjunction with clinical judgment, and further evaluation may be necessary to confirm the presence of sepsis or septic shock.

Sepsis Scoring Calculator, SOFA score, qSOFA score, Organ dysfunction assessment, Infection, Interactive tool, Calculator, Parameters, Clinical implications, Risk assessment, Sepsis, Septic shock, Patient outcomes, Hands-on experience, Informed decisions, Care provisionSepsis Scoring Calculator: Assessing Organ Dysfunction with the qSOFA (quick SOFA) ScoreqSOFA Score0000