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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, July 18, 2016

qSOFA does not replace SIRS

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Jean-Louis Vincent J L, Martin G & Levy M - Critical Care 2016; 20:210
DOI: 10.1186/s13054-016-1389-z
...We would like to stress that, although SIRS was part of the definition of sepsis in 1992 [3], the qSOFA is not part of the new sepsis definitions. This important difference is illustrated in Fig. 1, with panel A showing that infection and sepsis (by the 1992 definition) are virtually the same—infection without SIRS can be found, but it is relatively rare. By contrast, panel B shows that sepsis (by the new SEPSIS-3 definition) represents only a minority of cases of infection. Moreover, panel B illustrates important aspects of the sepsis definition vis-à-vis infection and qSOFA. For example, sepsis can be present without a qSOFA score ≥ 2 because different forms of organ dysfunction may be present than are assessed using the qSOFA, such as hypoxemia, renal failure, coagulopathy, or hyperbilirubinemia. In addition, a patient may have a qSOFA ≥ 2 without infection; for example, in other acute conditions, such as hypovolemia, severe heart failure, or large pulmonary embolism. Further work remains to be done to determine the predictive validity of qSOFA in such patients. Finally, infected patients may have a qSOFA ≥ 2 and not be septic because the degree of hypotension, tachycardia, and/or altered mentation needed to fulfill qSOFA criteria is not the same as that needed to meet the SOFA organ dysfunction criteria necessary for a diagnosis of sepsis; the qSOFA criteria are thus clinically valuable but imperfect markers of sepsis. Nevertheless, in an analysis of a database of more than 74,000 patients, Seymour et al. [11] recently reported that 75 % of patients with suspected infection who had two or more qSOFA points also had at least two SOFA points.
We hope this editorial will clarify that the qSOFA is meant to be used to raise suspicion of sepsis and prompt further action—it is not a replacement for SIRS and is not part of the definition of sepsis."