John P Donnelly, Monika M Safford, Nathan I Shapiro, John W Baddley, Henry E Wang

SIRS, SOFA, and qSOFA classifications identified different incidences and mortality. Our findings support the use of the SOFA and qSOFA classifications to identify patients with infection who are at elevated risk of poor outcomes. These classifications could be used in future epidemiological assessments and studies of patients with infection.

S. Maitra, A. Som, S. Bhattacharjee

To identify sensitivity, specificity and predictive accuracy of quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria to predict in-hospital mortality in hospitalized patients with suspected infection.

José Moreira, Ariane Paixão, Juliana Oliveira, Waldir Jaló, Ofélio Manuel, Rafaela Rodrigues, Alexandra Oliveira, Leonardo Tinoco, João Lima, Beatriz Grinsztejn, Valdiléa G. Veloso, André M. Japiassú, Cristiane C. Lamas

To compare the discriminatory capacity of the quick Sequential Organ Failure Assessment (qSOFA) versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting 30-day mortality and intensive care unit (ICU) admission in patients with suspicion of infection at an HIV reference center.

Rudd KE, Seymour CW, Aluisio AR, et al.

This pooled cohort analysis assesses the association of quick Sequential (Sepsis-Related Organ Failure Assessment (qSOFA) score with excess hospital death among patients with suspected infection in low- to middle-income countries and compares the mortality association using qSOFA vs systemic inflammatory response syndrome (SIRS) criteria.

Viale P, Tedeschi S, Scudeller L, et al.

AbstractBackground.To assess the impact on all-cause 14-day survival of the implementation of an infectious disease (ID) team for the early management of severe sepsis/septic shock (SS/SS) in the Emergency Department (ED).Methods.A quasi-experimental pre-post study was carried-out at the general ED of our 1,420-bed teaching hospital. During the pre phase (June 2013-July 2014) all consecutive adult patients with SS/SS were managed according to standard-of-care and data were prospectively collected. During the post phase (August 2014-October 2015), patients were managed in collaboration with a dedicated ID team by a bedside patient evaluation within 1 hour from ED arrival.Results.Overall, 382 patients were included, 195 in the pre and 187 in the post phase. Median age was 82 years (IQR 70-88). Most common infection sources were lung (43%) and urinary tract (17%), in 22% of cases infection source remained unknown. During the post phase the overall compliance with the Surviving Sepsis Campaign (SSC) bundle and the appropriateness of initial antibiotic therapy improved from 4.6% to 32% (P<0.001), and from 30% to 79% (P<0.001), respectively. At multivariate analysis, predictors of 14-day mortality were: qSOFA >= 2 [HR 1.68, 1.15-2.45, P=0.007], serum lactate >= 2 mmol/L [HR 2.13, 1.39-3.25, P<0.001], and unknown infection source [HR 2.07, 1.42-3.02, P<0.001], while being attended during the post phase was a protective factor [HR 0.64, 0.43-0.94, P=0.026].Conclusion.The implementation of an ID team dedicated to the early management of SS/SS in ED improved the adherence to SSC recommendation and patient survival.

Raith EP, Udy AA, Bailey M, et al.

This cohort study compares the accuracy of the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score, quick SOFA score, and Systemic Inflammatory Response Syndrome criteria for predicting in-hospital mortality or prolonged length of stay among adults admitted to the ICU with suspected infection in Australia and New Zealand.

Lamontagne F, Harrison DA, Rowan KM.

The identification of patients with possible sepsis is vitally important because timely recognition and appropriate, effective treatment substantially improves survival. Unlike some other life-threatening conditions (such as myocardial infarction), for which highly accurate diagnostic tests are available, no rapid diagnostic tests are currently available to accurately identify patients with sepsis (or those at high risk of developing sepsis) to help clinicians determine the best course of action. Development of such tests for sepsis will involve consideration of a number of key issues, such as whether sepsis is just one or, rather, multiple entities; whether degrees of having sepsis exist; which test is the gold standard (an accepted benchmark against which similar tests can be compared and diagnostic accuracy assessed); what levels of accuracy are sufficient for use in clinical practice; and which tests based on what markers are the most cost-effective. In the meantime, however, clinicians must rely on clinical judgment, potentially augmented by clinical criteria validated to identify sepsis among patients with infection.

Adhikari NJ, Rubenfeld GD.

In the past 2 years, sepsis has received considerable attention from the global community. In 2017, the World Health Assembly passed a resolution urging all 194 UN Member States to implement actions to reduce the burden of sepsis, and for the World Health Organization to report on the public health implications of sepsis and its global consequences. It has become clear that early resuscitation targeted to hemodynamic goals is more expensive and no more effective than routine care in high-income countries. In Zambia, a protocolized resuscitation strategy actually increased mortality. These data and other studies continue to suggest that some evidence on sepsis therapy does not generalize on a global scale.

Christian Brun-Buisson

Meta-analyses of accuracy of the qSOFA to predict hospital mortality of patients with suspected infection show suboptimal performance of this abridged score. However, a score composed of only 3 clinical variables, such as the qSOFA or CRB can hardly be very accurate, but can serve as a warning integrated into clinical decision making, to help triaging patients in the ED. qSOFA does not help identifying infection. More complete, generic severity scores are nevertheless of major interest for stratification or analyses of epidemiolgical studies and clinical trials in septic patients.

F. Wu, Y. Ye, X. Zhou

We read with interest the meta-analysis by Maitra et al. who found that quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) seemed to be a poorly sensitive predictive marker for in-hospital mortality in hospitalized patients with suspected infection [1]. Though the review sounds comprehensive and scientific, we have some different views to address.