Early Identification Value Of Combined With QSOFA And SIRS In Patients With Sepsis In Emergency Department

Objective:The definition of sepsis 3.0 proposed a rapid identification tool for sepsis screening:rapid sequential organ failure assessment(qSOFA).However,some studies have questioned the accuracy of qSOFA.The aim of this study was to analyze the early identification value of qSOFA and SIRS for the patients with suspected infection in emergency department.Method:A single center,prospective observational study was conducted on patients with suspected infections in emergency department in our hospital from March 1 to December 31,2017.All patients were assessed for qSOFA and SIRS.Sepsis 3.0 was defined as the diagnostic criteria for sepsis.All the patients were divided into two groups,the sepsis group and the non-sepsis group.We analyzed the distribution of different scores of qSOFA and SIRS,and calculated the sensitivity,specificity,positive predictive value and negative predictive value of qSOFA and SIRS for the diagnosis of sepsis.Result:The qSOFA score and SIRS score in the sepsis group was 1.29±0.73 and 2.58±0.92respectively,in the non-sepsis group was 0.67±0.55 and 1.56±0.99 respectively,both P<0.001.The area under the ROC curve for the diagnosis of sepsis by qSOFA was 0.721,and the AUROC for SIRS was 0.763,there was no significant statistical difference between the two scores(p>0.05).qSOFA≥1 and SIRS≥2 had high sensitivity(0.91,95%CI:0.86-0.93 and 0.88,95%CI:0.84-0.91,respectively),while qSOFA>2 had high specificity(0.96,95%CI:0.92-0.98).When qSOFA≥1 and SIRS≥2,the sensitivity for the diagnosis of sepsis was 0.84(95%CI:0.79-0.88),when qSOFA≥2 and SIRS≥2,the specificityfor the diagnosis of sepsis was 0.97(95%CI:0.94-0.99).Conclusion:Using qSOFA score or SIRS criteria alone is of limited value for the early identification of patients with sepsis,their combination may be more instructive for clinical practice.When qSOFA≥2 and SIRS≥2,sepsis should be considered.When qSOFA≥1 and SIRS≥2,we should pay more attention to determine whether there is sepsis.