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Recognizing the high-risk patients with sepsis on time: MEWS, qSOFA or SIRS?

Introduction: The third international consensus definition for sepsis introduced quick Sepsis-related Organ Failure Assessment (qSOFA) score to help recognize patients with sepsis who should be treated in ICU. Goals: To compare triaging value of two widely used scores: Systemic Inflammatory Response Syndrome (SIRS) and Modified Early Warning Score (MEWS) with qSOFA. Methods: Retrospective observational study at Vojvodina Institute for Pulmonary Diseases included 209 patients with sepsis treated at High Dependency Unit between January 2015 and November 2018. We recorded: sex, age, heart and respiratory rate, GCS, blood pressure, temperature, urine output, MEWS, qSOFA and SIRS. The accuracy of these three scores - qSOFA, SIRS and MEWS was then compared for mortality prediction. Results: Out of 209 patients, 141 (67.5%) were male. Mean age was 60.1 (SD±15.08). Intrahospital mortality was 45.9%. MEWS had the highest discrimination for intrahospital mortality (AUC 0.69; 95% CI 0.63 to 0.76), followed by qSOFA (AUC 0.65; CI 0.58 to 0.71) and SIRS (AUC 0.57; 95% CI 0.50 to 0.64). SIRS had the highest sensitivity (68.75% CI 58.5 – 77.8%), followed by MEWS ≥5 (52.08%, CI 41.6-62.4%), and qSOFA (22.91%, CI 15.0–32.6%). The specificity of qSOFA with 89.38% (CI 82.2 – 94.4%) was similar to MEWS (87.61%, CI 80.1 – 93.1%), followed by SIRS (46.02%, CI 36.6 – 55.6%). Conclusion: MEWS had the highest overall accuracy, followed by qSOFA. However, SIRS score had the highest sensitivity in identifying septic patients with high risk of intra-hospital mortality. qSOFA sensitivity is worryingly low, which questions its value in timely recognition of high-risk patients with sepsis, which is a time-critical condition.