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qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis
  1. Robert Goulden1,
  2. Marie-Claire Hoyle1,
  3. Jessie Monis1,
  4. Darran Railton1,
  5. Victoria Riley1,
  6. Paul Martin1,
  7. Reynaldo Martina2,
  8. Emmanuel Nsutebu1
  1. 1Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
  2. 2Department of Biostatistics, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Emmanuel Nsutebu, Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool L78XP, UK; emmanuel.nsutebu{at}


Background The third international consensus definition for sepsis recommended use of a new prognostic tool, the quick Sequential Organ Failure Assessment (qSOFA), based on its ability to predict inhospital mortality and prolonged intensive care unit (ICU) stay in patients with suspected infection. While several studies have compared the prognostic accuracy of qSOFA to the Systemic Inflammatory Response Syndrome (SIRS) criteria in suspected sepsis, few have compared qSOFA and SIRS to the widely used National Early Warning Score (NEWS).

Methods This was a retrospective cohort study carried out in a UK tertiary centre. The study population comprised emergency admissions in whom sepsis was suspected and treated. The accuracy for predicting inhospital mortality and ICU admission was calculated and compared for qSOFA, SIRS and NEWS.

Results Among 1818 patients, 53 were admitted to ICU (3%) and 265 died in hospital (15%). For predicting inhospital mortality, the area under the receiver operating characteristics curve for NEWS (0.65, 95% CI 0.61 to 0.68) was similar to qSOFA (0.62, 95% CI 0.59 to 0.66) (test for difference, P=0.18) and superior to SIRS (P<0.001), which was not predictive. The sensitivity of NEWS≥5 (74%, 95% CI 68% to 79%) was similar to SIRS≥2 (80%, 95% CI 74% to 84%) and higher than qSOFA≥2 (37%, 95% CI 31% to 43%). The specificity of NEWS≥5 (43%, 95% CI 41% to 46%) was higher than SIRS≥2 (21%, 95% CI 19% to 23%) and lower than qSOFA≥2 (79%, 95% CI 77% to 81%). The negative predictive value was 88% (86%–90%) for qSOFA, 86% (82%–89%) for SIRS and 91% (88%–93%) for NEWS. Results were similar for the secondary outcome of ICU admission.

Conclusion NEWS has equivalent or superior value for most test characteristics relative to SIRS and qSOFA, calling into question the rationale of adopting qSOFA in institutions where NEWS is already in use.

  • infection
  • diagnosis
  • clinical assessment
  • infectious diseases
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  • Contributors RG and EN conceived of the study. RG, EN and RM designed the analysis. RG performed the analysis and wrote the first draft of the manuscript. All authors contributed to data collection, interpretation of the data and revision of the manuscript.

  • Competing interests None declared.

  • Ethics approval Ethics approval was provided by an NHS Research Ethics Committee (reference 17/NE/0140).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All Stata code used in the creation of this study is available from the lead author on request.

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