This sepsis qSOFA score calculator evaluates mortality risk in patients with suspected and diagnosed infections, as per 2017 Surviving Sepsis Guidelines.
How does this sepsis qSOFA score calculator work?
This quick SOFA score tool predicts adverse outcome in patients that are suspected with sepsis outside intensive care units.
Introduced recently in 2016 by the Sepsis 3 group, the score also provides an updated definition of sepsis and aims to move clinical judgment away from the previous SIRS criteria. By 2017 Surviving Sepsis Guidelines, the score is not included as sepsis diagnosis tool.
The three items in the sepsis qSOFA score calculator are:
■ Altered Mental Status (GCS <15) – assessed through bedside Glasgow coma scale with the 15 points cut off value between abnormal and normal.
■ Respiratory Rate ≥22 breaths per minute – increased respiratory rate.
■ Systolic Blood Pressure ≤100 mmHg – lowered SBP.
The quick sepsis related organ failure assessment replaces the unspecific, insensitive and limiting SIRS definition. Standard intervention for sepsis includes fluid resuscitation, antibiotics, source monitoring.
As a simplified version of SOFA, the score contains only three criteria and removes the time constraints of the complete score that requires waiting for laboratory tests.
qSOFA focuses on identifying patients with confirmed or suspected infections who are at risk of developing sepsis, followed by ICU stay of three or more days or mortality.
The construct and criterion validity was compared with the complete SOFA score, changes in the score, SIRS criteria and the logistic organ dysfunction score (LODS).
The study claims that 70% mortality was accounted by 24% patients with 2 or 3 qSOFA criteria present.
By comparison, SOFA predictive validity for in-hospital mortality is statistically greater than qSOFA or SIRS, however, in out of ICU suspected infections, the predictive validity of qSOFA is greater than that of SOFA and SIRS.
qSOFA score interpretation
When none or 1 of the criteria is present, in-hospital mortality caused by sepsis remains unlikely but possible and the patient should continue to be monitored if sepsis is suspected. Initiation of appropriate treatment is recommended if needed and the score should be regularly reassessed.
When 2 or all of the criteria are met, the qSOFA indicates increasingly high likelihood of in-hospital mortality due to sepsis. Serum lactate testing and the application of the Sequential Organ Failure Assessment (SOFA) Score to evaluate organ dysfunction are required.
Current research looks at whether or not serum lactate should be included in the score but to date, statistical relevance showed there is little improvement in specificity with this fourth criterion.
Sepsis and septic shock definitions
The Third International Sepsis Consensus Definitions Task Force (19 critical care, infectious disease, surgical, and pulmonary specialists) defines sepsis as "as life-threatening organ dysfunction due to a dysregulated host response to infection".
The definition continues with " For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%."
Septic shock is now defined as a subset of sepsis with abnormalities in the circulatory, cellular and metabolic areas and posing a greater mortality risk than sepsis (more than 40%).
Septic shock carries a vasopressor requirement to maintain a mean arterial pressure of 65 mmHg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia.
Limitations and criticism around quick SOFA (qSOFA) score
■ Sepsis remains a broad term in research and clinical practice and attempts to provide a definition emphasize generalizability.
■ Discussion around the fact that serum lactate measurement is an essential biochemical identifier of sepsis and should be present in the score.
■ The fact that the score needs to be interpreted by a clinician and not meeting the criteria doesn’t exclude sepsis.
■ The task force doesn’t provide a world wide perspective with no contribution from low, middle- income countries and the score being used only in adult populations.
■ The tool still requires validation and further studies to incorporate it.
References
1) Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. (2016) The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA; 315(8):801-10.
2) Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M; Sepsis Definitions Task Force. (2016) Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA; 315(8):775-87.
3) Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, Rubenfeld G, Kahn JM, Shankar-Hari M, Singer M, Deutschman CS, Escobar GJ, Angus DC. (2016) Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA; 315(8):762-74.
10 May, 2016