Assessing the Predictive Value of qSOFA in Early Detection of Sepsis/Septic Shock in Adult Medical Surgical Unit Patients

Abstract

Background: Sepsis and septic shock are significant causes of morbidity and mortality in hospitalized patients, particularly in medical-surgical units. Timely recognition of sepsis is crucial for improving outcomes, but early identification remains a challenge. Screening tools such as the Quick Sequential Organ Failure Assessment (qSOFA) score and the EPIC Sepsis Model (ESM) are commonly used to identify patients at risk for sepsis. However, the predictive value of these tools during Rapid Response Team (RRT) activation in medical-surgical units has not been fully evaluated Aim: This study aims to assess and compare the predictive value of qSOFA alone qSOFA and ESM together in identifying sepsis and septic shock among adult medicalsurgical unit patients at the time of RRT activation. Methods: A retrospective observational cohort design was employed to analyze data collected from January to April 2024 at a tertiary medical center (American university of Beirut medical center). In addition, prospective data collection was utilized during the Month of August 2024 to increase reliability of data collection. The predictive accuracy of qSOFA and ESM was evaluated in the matters of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In addition, ROC analysis, with Area Under the Curve (AUC) values calculated for each tool to assess their ability to predict sepsis-related outcomes, including mortality, ICU admissions, and sepsis progression. Results: In total 146 charts were reviewed; Different thresholds of these two tools were considered (qSOFA ≥2, ESM≥6, and ESM≥10) to compare the results of each tool in comparison with the actual septic status of patients 24 hours after RRT activation. The results of the retrospective analysis showed that qSOFA had a higher AUC (0.908) with sensitivity = 75% and specificity = 92% compared to ESM (AUC = 0.704), which had sensitivity = 88% and specificity = 42%. In the prospective analysis, qSOFA demonstrated a superior AUC of 0.827, with sensitivity = 72% and specificity = 86%, while ESM had a much lower AUC of 0.448, with sensitivity = 100% and specificity = 27%. These findings indicate that qSOFA was more effective in predicting sepsisrelated outcomes than ESM. Discussion: The findings suggest that qSOFA is a more reliable tool for early sepsis detection during RRT activation in medical-surgical units. ESM, while useful in ruling out non-septic cases, yielded in higher false positive rates limiting its clinical utility in this setting. The results underscore the importance of utilizing qSOFA for earlyintervention in sepsis management. This project suggests the ordering of serum lactate, frequent monitoring and fluid administration for every patient with qSOFA ≥2 on RRT activation. Further research is needed to optimize these tools for broader clinical implementation and to explore the potential for combining predictive models with biomarkers to improve accuracy in sepsis detection.