Comparison of the qSOFA and NEWS scores and the SIRS criteria in predicting outcomes in emergency department patients with and without infection: results from a prospective observational study
Objective. To compare the Quick Sequential (Sepsis-Related Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS) and Systemic Inflammatory Response Syndrome (SIRS) scores value in predicting poor outcomes in emergency department patients with/without infection in Russia. Materials and methods. This prospective observational study included data from 270 patients, of whom 132 (48.8%) patients had an infection and 138 (51.2%) did not have an infection. Comparison of areas under the ROC-curves (Receiver Operating Characteristic Curve) for the qSOFA, NEWS and SIRS scores in predicting the composite outcome (death and/or length of intensive care unit stay >1 day) was performed. Results. A total of 24 (8.8%) patients had the composite outcome. For prediction of the composite outcome in patients without infection, the area under the ROC-curve of the NEWS score (0.908 [95% CI 0.847-0.951]) was not significantly different to the area under the ROC-curve of the qSOFA score (0.839 [95% CI 0.767-0.896]), p = 0.255, and was significantly superior to the area under the ROC-curve of the SIRS score (0.776 [95% CI 0.698-0.843]), p = 0.011. The difference between the areas under the ROC-curves of the qSOFA and SIRS scores was not significant (p = 0.379). In the group of patients with infection the area under the ROC-curve of the NEWS score (0.808 [95% CI 0.731-0.872]) was significantly superior to the areas under the ROC-curves of the qSOFA score (0.715 [95% CI 0.630-0.790]), p = 0.004, and the SIRS score (0.641 [95% CI 0.553-0.722]), p = 0.015. The difference between the areas under the ROC-curves of the qSOFA and SIRS scores was not significant (p = 0.286). Conclusions. The NEWS score has better prognostic value than the qSOFA and SIRS scores in predicting poor outcome in emergency department patients, irrespective of their infection status. The advantage of the NEWS score over the qSOFA score is more significant in patients with infection. Prognostic values of the qSOFA and SIRS scores are comparable in the both patient groups.