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Comparative Study between SOFA and qSOFA of Early Detection of Sepsis in Patients Admitted in Critical Care Unit

Amutha Arockia Mary

Introduction: The goal of Surviving sepsis campaign is to improve the patients’ outcome who suffers from sepsis that makes it vital to have defined policies and protocols to detect sepsis at the earliest and treat. The global burden of sepsis in relationship to mortality and morbidity ratio is increasing. But there is very minimal data about its occurrence in India.

It is been estimated that more than 30 million people are affected by sepsis globally among which 6 million death happens every year. This triggers the need for early detection. There are various predictive tools used to detect sepsis and mortality. SOFA score one among them which is in use since 1994. qSOFA is also a predictive tool which was recommended by the Sepsis-3 consensus to be used as a predictor outside the ICU. Sepsis related mortality is more in India as compared with its western counterparts. The aim of the research is to compare and determine the predicting ability of the tools qSOFA and SOFA when used upon patients with suspected infection at Emergency department and critical care units in the setting of tertiary care teaching hospitals at Navi Mumbai.

Methodology: The researcher conducted prospective observational non-experimental quantitative study on 100 patient samples. This study compared two tools to detect the effectiveness in predicting sepsis at the earliest. This study is conducted at Emergency department using qSOFA score and is conducted at critical care unit using SOFA criteria, at selected tertiary care teaching hospitals at Navi Mumbai. These institutions were selected for the study on the basis of ease in availability of the sample, researcher’s accessibility and familiarity with the institutions. The sensitivity and specificity of qSOFA and SOFA were assessed by area under the receiver operating curve (AUROC). The calculated sensitivity of qSOFA was 100%, with AUROC 0.70 (81.47% to 100% CI) and the specificity of qSOFA was 37.50%. The recorded sensitivity of SOFA was 95.45% with AUROC of 0.68 (77.16% to 99.88% CI).

Results: In patients with suspected infection the AUROC of qSOFA in predicting sepsis was 0.70 (81.47% to 100% CI) with 100% sensitivity and 37.50% specificity in comparison to the AUROC of SOFA score which was 0.68 (81.47% to 100% CI) with 95.45% sensitivity and 39.29% specificity. The outcome was measured on the basis of patient shifted to ward, shifted to critical care unit and in hospital death.

Conclusion: According to the observation made our study concludes that qSOFA has 100% sensitivity to detect sepsis at the earliest when applied on patients with suspected infection at emergency department in comparison to SOFA score when applied on patients with suspected infection at critical care units of tertiary care teaching hospital emergency department and critical care unit at Navi Mumbai. The researcher also found that the hurdle to the early detection is the signs and symptoms that are noticed during the normal course of infection leads to the increase of false positive. In spite of that the researcher found it is recommended to detect sepsis at the earliest with pre planned protocols utilizing effective tools and local healthcare policies as it is a global burden with a complex nature. Further research in this arena is highly recommended to generalize the findings.

Keywords: Sepsis; qSOFA; SOFA; Predictive tools.