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A comparison of pre ICU admission SIRS, EWS and q SOFA scores for
predicting mortality and length of stay in ICU
Shahla Siddiqui, MBBS, DABA, FCCM ⁎, Maureen Chua, MBBs, MMed,
Venkatesan Kumaresh, MBBS, FRCA, EDIC, Robin Choo, MS
a
Anaesthesia and Intensive Care, Khoo Teck Puat Hospital, Singapore
b
MOhh, Singapore
c
KTPH, Singapore
d
Yishun Comm. Hospital, Singapore.
a r t i c l e i n f o a b s t r a c t
Available online xxxx Introduction: The 2015sepsis definitions suggest using the quick SOFA score for risk stratification of sepsis pa-
Keywords: tients among other changes in sepsis definition. Our aim was to validate the q sofa score for diagnosing sepsis
Sepsis 3 and comparing it to traditional scores of pre ICU admission sepsis outcome prediction such as EWS and SIRS in
q SOFA our setting in order to predict mortality and length of stay.
Risk stratification Methods: This was a retrospective cohort study. We retrospectively calculated the q sofa, SIRS and EWS scores of
all ICU patients admitted with the diagnosis of sepsis at our center in 2015. This was analysed using STATA 12.
Logistic regression and ROC curves were used for analysis in addition to descriptive analysis.
Results: 58 patients were included in the study. Based on our one year results we have shown that although q
SOFA is more sensitive in predicting LOS in ICU of sepsis patients, the EWS score is more sensitive and specific
in predicting mortality in the ICU of such patients when compared to q SOFA and SIRS scores.
Conclusion: In conclusion, we find that in our setting, EWS is better than SIRS and q SOFA for predicting mortality
and perhaps length of stay as well. The q Sofa score remains validated for diagnosis of sepsis.
© 2017 Elsevier Inc. All rights reserved.
1. Introduction threshold for ICU admission but is not specific for sepsis. The q SOFA
score is a composite of clinical signs (hypotension b 100 SBP, altered
Since the advent of the new sepsis definitions by The Third Interna- consciousness, GCS b 15, and a respiratory rate N 22 bpm) which has a
tional Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [1] high internal validity in the Sepsis 3 study for outcome prediction. The
in early 2016 many publications urge the validation of the suggested q score ranges from 0 to 3 points. The presence of 2 or more q SOFA points
SOFA score in local contexts. The authors of the new definitions them- at the onset of infection was associated with a greater risk of death or
selves urge further epidemiological research in this arena. Sepsis is de- prolonged intensive care unit stay [6]. These are outcomes that are
fined as “a life threatening syndrome which is due to a dysregulated more common in infected patients who may be septic than those with
host response and causes organ dysfunction” [2]. Patients admitted uncomplicated infection. Based upon these findings, the Third Interna-
with sepsis to the ICU were evaluated for severity using the SIRS (sys- tional Consensus Definitions for Sepsis recommends q SOFA as a simple
temic inflammatory response score) or EWS (early warning score), prompt to identify infected patients outside the ICU. The internal valid-
however after the new definition has been published we are urged to ity of the q SOFA score for predicting poor outcomes (LOS and mortality)
use q SOFA score in the preadmission period for prediction of adverse was high. The authors concluded that the initial, retrospective analysis
outcomes [3]. SIRS has been the oldest definition of mild sepsis but indicated that q SOFA could be a useful clinical tool, especially to physi-
has been criticized for having a poor specificity [4]. The presence of N 2 cians and other practitioners working outside the ICU to promptly iden-
SIRS criteria in non-infectious cases has led to its use being obsolete in tify infected patients likely to fare poorly [7]. However, because most of
sepsis outcomes prediction. The early warning score based on 6 physio- the data were extracted from only US databases, the task force strongly
logic scores have been widely adopted in UK hospitals and is the norm encourages prospective validation in non-US health care settings to
for pre ICU assessment in sepsis patients [5]. A score of four is a confirm its robustness and potential for incorporation into future clini-
cal management [8].
⁎ Corresponding author. Our aim was to compare the q SOFA score with SIRS and EWS score
E-mail address: Siddiqui.shahla@alexandrahealth.com.sg (S. Siddiqui). traditionally used in our setting for pre ICU risk prediction in sepsis
http://dx.doi.org/10.1016/j.jcrc.2017.05.017
0883-9441/© 2017 Elsevier Inc. All rights reserved.
192 S. Siddiqui et al. / Journal of Critical Care 41 (2017) 191–193
patients. We wished not only to validate q SOFA for diagnosis of sepsis Table 2
but also to study its efficacy in predicting mortality and length of stay. The association between different sepsis assessment tools and mortality.
Notes: SD = Standard Deviation. Fig. 1. Combined ROC curves of q SOFA, SIRS and EWS with patient mortality outcome.
S. Siddiqui et al. / Journal of Critical Care 41 (2017) 191–193 193