Comparison of the accuracy of qSOFA and MEWS score for early detection of sepsis

Abstract

MEWS is a scoring that has been observed for early enforcement of severe sepsis in ED (78,8% sensitivity), whereas qSOFA is a scoring that is still debatable in determining suspicious sepsis patients that is recommended by International Consensus Sepsis-3. The objective of this study is to compare the accuracy between newly applied qSOFA score with previously investigated MEWS in predicting early sepsis in septic patients at Emergency Department (ED), Saiful Anwar General Hospital (SAGH), Malang – Indonesia. This is an observational cross-sectional study to assess the accuracy of qSOFA compared to MEWS in determining early diagnosis of sepsis. We collected the data of patients diagnosed with sepsis for 5 months (July to November 2017) at ED in SAGH Malang. There were 74 patients who met our inclusion criteria. We used lactic acid value of ≥2 as cut off value to diagnose patients with sepsis. Our research data shows that to determine sepsis, qSOFA and MEWS (cut off lactate ≥2) have sensitivity 93.8% vs 81.5%, PPV 87.1% vs 88.3%, Specificity 0% vs. 22.2%, NPV 0% vs 14.3%, Accuracy 82.4 % vs. 74.3%. In addition, the comparison of qSOFA and MEWS as diagnostic tests to predict 24-hour mortality in ED has an accuracy of 22% vs 40.5%, 100% sensitivity vs 94% and specificity 7.1% vs. 23%. qSOFA is more accurate than MEWS in determining suspected sepsis patients (82.4% vs 74.3%) based on lactic acid so that qSOFA can be used as a scoring tool of sepsis at ED Saiful Anwar Hospital. However, qSOFA and MEWS still cannot be used as a scoring tool for predicting 24-hour mortality in ED due to its very low accuracy (22% vs 40.5%) although MEWS accuracy is higher than qSOFA.

Keywords

• Lactate levels
• MEWS
• qSOFA
• sepsis