Comparison of qSOFA, SIRS, NEWS and REWS Scores in Predicting Severity and 28-day Mortality of older Suspected Sepsis Cases; a Prognostic Accuracy Study.

Introduction: Various scores have been developed to predict sepsis mortality. This Study aimed to evaluate the accuracy of the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), National Early Warning Score (NEWS) and Ramathibodi Early Warning Score (REWS) for predicting severity and 28-day mortality of elderly suspected sepsis cases in emergency department (ED). Methods: This prognostic accuracy study was performed using data obtained from patients aged ≥ 60 years with suspected sepsis who visited the Ramathibodi Hospital ED between May and December 2019. The accuracy of NEWS, SIRS, REWS, and qSOFA in predicting the studied outcomes were evaluated using the receiver operating characteristic (ROC) curve analysis. Results: A total of 531 cases with the mean age of 77.6 ± 9.39 (range: 60-101) years were evaluated (45% male). The overall 28-day mortality was 11.6%. The area under ROC curve of qSOFA scores ≥2 showed moderate discrimination (0.66, 95% confidence interval [CI]: 0.59-0.73) in predicting mortality, which was significantly higher than SIRS ≥2 (ROC: 0.56, 95% CI: 0.50-0.63; p=0.04), NEWS ≥5 (ROC: 0.56, 95% CI: 0.50-0.63; p=0.01), and REWS ≥4 (ROC: 0.56, 95% CI: 0.50-0.63; p<0.01). Conclusions: qSOFA score ≥2 was superior to SIRS ≥2, NEWS ≥5, and REWS ≥4 in predicting 28-day mortality and septic shock in elderly patients with suspected sepsis in the ED. However, the predictive performance of qSOFA ≥2 was only moderate (AUC<0.8). Therefore, to reduce mortality and improve outcomes, we suggest the use of qSOFA ≥2 combined with clinical or other early warning scores, or the development of new prediction scores for screening, triage, and prediction of mortality and of severity of sepsis in elderly patients with suspected sepsis in the ED.