Key result
qSOFA underperforms the Mannheim Peritonitis Index in predicting in-hospital mortality for complicated intra-abdominal infections.
Why the study?
Complicated intra-abdominal infections remain associated with high morbidity and mortality, and no widely accepted early prognostic scoring system exists.
Does the qSOFA score accurately predict mortality in patients with complicated intra-abdominal infections compared to MPI and SIRS?
Observational (n=110)
No
Does the qSOFA score accurately predict mortality in patients with complicated intra-abdominal infections compared to MPI and SIRS?
Effect estimate: Difference in AUROC 0.146 (95% CI 0.0199-0.272)
Absolute Event Rate: 0.698% vs 0.844%
p-value: p=0.0232
The qSOFA score has poor prognostic accuracy for predicting mortality in patients with complicated intra-abdominal infections, performing worse than the Mannheim Peritonitis Index.
qSOFA's poor accuracy cautions against its use for prognosis in complicated intra-abdominal infections; leaves open identification of optimal scores.
BACKGROUND: Despite the evolution in surgical treatment and antimicrobial therapy in the last years the complicated intra-abdominal infections (cIAIs) are still associated with high morbidity and mortality. Different scoring systems are already available for early prognostic evaluation and yet none has been widely accepted. AIM: Our aim was to evaluate the prognostic accuracy of quick sequential organ failure assessment (qSOFA), one of the most recent scores, in patients with cIAIs. MATERIALS AND METHODS: We studied retrospectively 110 patients with cIAIs admitted to the Department of Surgical Diseases (DSD) at University Hospital “Prof. Dr. Stoyan Kirkovich” Stara Zagora from January 2017 to July 2019. Area under receiver operating characteristics (AUROC) curves of systemic inflammatory response syndrome (SIRS), qSOFA, and Mannheim Peritonitis Index (MPI) were analyzed and a comparison of ROC curves was performed to explore their prognostic performance. RESULTS: Twenty-five (22.7%) patients died during hospitalization. qSOFA score showed poor prognostic accuracy (AUROC = 0.698, 95% CI = 0.566–0.829), worse than MPI score (AUROC = 0.698 vs. 0.844), but better than SIRS (AUROC = 0.698 vs. 0.583). The qSOFA score ≥2 points was observed with lack of sensitivity (32.0%) as outcome predictor. ROC curve analysis showed prognostic inferiority of qSOFA compared to MPI (difference between areas = 0.146, p = 0.0232). CONCLUSION: In patients with cIAIs, quick-SOFA score was observed with poor prognostic performance.
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Dimitrov et al. (2020) conducted an observational in Complicated intra-abdominal infections (n=110). qSOFA score vs. Mannheim Peritonitis Index (MPI) was evaluated on Prognostic accuracy for in-hospital mortality (AUROC) (Difference in AUROC 0.146, 95% CI 0.0199-0.272, p=0.0232). The qSOFA score demonstrated poor prognostic accuracy for in-hospital mortality in patients with complicated intra-abdominal infections (AUROC 0.698), performing significantly worse than the Mannheim Peritonitis Index.
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