What are the appropriate scoring systems to use in managing sepsis (Systemic Inflammatory Response Syndrome) and their indications?

From the Guidelines

The Sequential Organ Failure Assessment (SOFA) score and the quick SOFA (qSOFA) score are the primary tools recommended for identifying organ dysfunction in potentially septic patients, with the SOFA score evaluating six organ systems and the qSOFA score looking at three criteria: altered mental status, systolic blood pressure ≤100 mmHg, and respiratory rate ≥22 breaths/minute. When managing sepsis, several scoring systems can be useful, but the SOFA score and qSOFA score are the most recommended. The SOFA score evaluates six organ systems (respiratory, cardiovascular, hepatic, coagulation, renal, and neurological) with scores ranging from 0-4 for each system, as described in the 2024 clinical practice guideline update by the infectious diseases society of America 1. An acute increase of 2 or more SOFA points indicates organ dysfunction consistent with sepsis.

• The qSOFA score can be used for rapid bedside assessment, which looks at three criteria: altered mental status, systolic blood pressure ≤100 mmHg, and respiratory rate ≥22 breaths/minute, as mentioned in the european association of urology guidelines on urological infections: summary of the 2024 guidelines 1.
• A qSOFA score of 2 or more suggests higher mortality risk and should prompt further evaluation.
• The Systemic Inflammatory Response Syndrome (SIRS) criteria, while less specific, can help identify infection, and lactate levels should be measured, with levels >2 mmol/L indicating tissue hypoperfusion, as discussed in the management of intra-abdominal infections from a global perspective: 2017 wses guidelines for management of intra-abdominal infections 1. These scores should be used immediately upon suspicion of infection to guide timely intervention, as each hour delay in appropriate antimicrobial therapy increases mortality by approximately 7-8%, and the scoring systems help clinicians objectively assess severity, track progression, and determine appropriate interventions including fluid resuscitation, vasopressor support, and antimicrobial therapy.

From the Research

Sepsis Management Scores

The following scores are used to manage sepsis:

• SOFA (Sequential Organ Failure Assessment) score
• qSOFA (Quick SOFA) score
• LODS (Logistic Organ Dysfunction System) score

When to Use Each Score

• SOFA score: can be used to predict the prognosis of septic patients, with higher accuracy than qSOFA score 2, 3, 4, 5
• qSOFA score: simpler to use, making it a more suitable tool in an emergency setting, but has lower accuracy than SOFA and LODS scores 2, 3, 6, 4
• LODS score: has higher accuracy than qSOFA score, but its use is less commonly reported in the literature 2

Key Findings

• The SOFA score has a high discriminative ability to predict emergency and in-hospital mortality, with an area under the receiver operating characteristic curve (AUC) of 0.89 3
• The qSOFA score has a lower AUC than the SOFA score, but is still useful for predicting critical illness in patients with sepsis 6
• The combination of SOFA score, qSOFA score, and △SOFA score has a high AUC for diagnosing sepsis and assessing the condition and prognosis of patients with sepsis 4
• The SOFA score is a simple and effective method to describe organ dysfunction/failure in critically ill patients, and can be used to monitor patient condition and disease development 5

Score Interpretation

• SOFA score: a higher score indicates greater organ dysfunction and higher mortality risk 2, 3, 4, 5
• qSOFA score: a score of 2 or more indicates a higher risk of mortality and critical illness 3, 6
• LODS score: a higher score indicates greater organ dysfunction and higher mortality risk 2