SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis

ABSTRACT

Background

We compared Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Quick Sepsis-related Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) for sepsis diagnosis and adverse outcomes prediction.

Methods

Clinical studies that used SIRS, SOFA, qSOFA, and NEWS for sepsis diagnosis and prognosis assessment were included. Data were extracted, and meta-analysis was performed for outcome measures, including sepsis diagnosis, in-hospital mortality, 7/10/14-day mortality, 28/30-day mortality, and ICU admission.

Results

Fifty-seven included studies showed good overall quality. Regarding sepsis prediction, SIRS demonstrated high sensitivity (0.85) but low specificity (0.41), qSOFA showed low sensitivity (0.42) but high specificity (0.98), and NEWS exhibited high sensitivity (0.71) and specificity (0.85). For predicting in-hospital mortality, SOFA demonstrated the highest sensitivity (0.89) and specificity (0.69). In terms of predicting 7/10/14-day mortality, SIRS exhibited high sensitivity (0.87), while qSOFA had high specificity (0.75). For predicting 28/30-day mortality, SOFA showed high sensitivity (0.97) but low specificity (0.14), whereas qSOFA displayed low sensitivity (0.41) but high specificity (0.88).

Conclusions

NEWS independently demonstrates good diagnostic capability for sepsis, especially in high-income countries. SOFA emerges as the optimal choice for predicting in-hospital mortality and can be employed as a screening tool for 28/30-day mortality in low-income countries.

KEYWORDS:

• Sepsis
• diagnosis
• mortality
• SIRS
• SOFA
• qSOFA
• NEWS

Article highlights

• Compared with SIRS, SOFA, and qSOFA, NEWS demonstrates higher sensitivity and specificity for the diagnosis of sepsis, especially in high-income countries.

• SOFA is superior to SIRS, qSOFA, and NEWS in predicting in-hospital mortality among patients with sepsis.

• SOFA can serve as a screening tool for predicting 28/30-day mortality in patients with sepsis in low-income countries. Combining the high specificity of qSOFA can lead to more accurate prognostic outcomes.

Abbreviations list

AUROC	=	area under the receiver operating characteristic curve
CI	=	confidence interval
DOR	=	diagnostic odds ratio
ED	=	emergency department
FN	=	false negative
FP	=	false positive
ICD	=	International Classification of Diseases
ICU	=	intensive care unit
NEWS	=	National Early Warning Score
NLR	=	negative likelihood ratio
PLR	=	positive likelihood ratio
qSOFA	=	Quick Sepsis-related Organ Failure Assessment
QUADAS-2	=	Quality Assessment of Diagnostic Accuracy Studies Tool-2
RevMan	=	Review Manager
SIRS	=	Systemic Inflammatory Response Syndrome
SOFA	=	Sequential Organ Failure Assessment
TN	=	true negative
TP	=	true positive

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Geolocation information

1. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610,041, China. 2. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan 610,041, China.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

All data generated or analyzed during this study are included in this publication.

Author contributions

X. Qui, Y-P L, and R-X Z conceived the study. R-X Z conducted the literature search. X. Qui, Y-P L, and R-X Z. screened the full-text papers and extracted the data. X. Qui, Y-P L ran the analysis. RZ drafted the manuscript, and all authors provided input into revisions and approved the final draft for submission.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2023.2237192

Additional information

Funding

This paper was not funded.