Pavlina PenevaMedical University of Varna, Bulgaria
Title: The use of the scoring systems - qSOFA and SIRS: a single-center clinical trial
New definitions of sepsis and septic shock were redefined in 2016. Since that time numerous studies have investigated the potential use of the qSOFA (quick Sequential Organ Failure Assessment score) as a screening tool for sepsis. Since then, there have been many questions about qSOFA and SIRS (Systemic Inflammatory Response Syndrome): Which scale is better? There are studies that National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) are more accurate. While most of the countries use the Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM) definitions, such definitions are not accepted all over the world. This study compares the performance of qSOFA with that of SIRS criteria for diagnosis of sepsis and prediction of 30-day mortality.
Methods: A prospective, non-interventional single-center clinical trial was conducted at St. Marina University Hospital in Varna. The sample included 87 patients with sepsis and sepsis shock. The criteria for inclusion in the study were laboratory constellation for systemic exposure; over 18 years of age; with or without co-morbidities; no malignancies. Pregnancy, neoplasia and the age of under 18 were the criteria for exclusion. Logistic regression was used to test the predictability of both scales. ROC curve analysis determined the sensitivity and specificity of SIRS and qSOFA.
Results: Our analysis showed that both SIRS and qSOFA are significant predictors of mortality of septic patients. The SIRS scale had a 2,050-fold probability of predicting the death of the patient (p=0.004, 95% CI 1.255-3.349) whereas the qSOFA score was 2.581 times more likely to predict mortality in patients with sepsis and septic shock (p=0.0001, 95% CI 1.557- 4.279). Cut-off points for SIRS more than 2.5 points showed 91% sensitivity and 60% specificity (AUC 0.80, 95% CI-0.712-0.907) whereas qSOFA scores greater than 1.5 points indicated sensitivity of 82.2% and specificity of 70.3% (AUC 0.85, 95% CI 0 0.770-0.934).
Conclusions: Our results indicated that qSOFA score had better predictive value for the detection of severe conditions in septic patients and a greater likelihood of death predictability at 30-day follow-up.
She graduated in Medicine in 2001 at the Medical University of Varna, Bulgaria. She has two specialties in Internal medicine and Pulmonary diseases. In 2019, she defended her doctoral degree on the topic "Prognostic markers for clinical and laboratory sepsis patient evaluation". She works as an associate professor at the Medical University of Varna, Bulgaria, and she takes part in teaching medical students. She has a Master's degree in "Health Management and Medico-Social Care", and her areas of interest are emergency medicine, intensive care, quality of patient care, and the use of artificial intelligence in medical practice.