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 quick SOFA (qSOFA) are the most important scoring systems to use in managing sepsis, with the SOFA score used to identify organ dysfunction and assess severity, and the qSOFA score used for rapid assessment in non-ICU settings. The SOFA score evaluates respiratory, coagulation, liver, cardiovascular, central nervous system, and renal parameters, and a change in SOFA score of 2 or more points indicates organ dysfunction consistent with sepsis 1. The qSOFA score is a bedside tool that looks at altered mental status, respiratory rate ≥22/min, and systolic blood pressure ≤100 mmHg; a score of 2 or more suggests higher mortality risk and need for escalation of care 1, 2.

Key Scoring Systems

• SOFA score: used to identify organ dysfunction and assess severity in patients with suspected infection
• qSOFA score: used for rapid assessment in non-ICU settings, looking at altered mental status, respiratory rate, and systolic blood pressure
• Other useful scores: National Early Warning Score (NEWS) for tracking clinical deterioration, Systemic Inflammatory Response Syndrome (SIRS) criteria for identifying inflammatory response, and lactate levels (>2 mmol/L indicating tissue hypoperfusion)

When to Use Scoring Systems

These scores should be used at initial presentation and regularly throughout treatment to guide management decisions, including fluid resuscitation, antibiotic administration, and ICU transfer 2. While these scoring systems help identify at-risk patients, they should complement rather than replace clinical judgment, as no single score perfectly predicts outcomes in all patients with sepsis. The most recent guidelines from 2024 support the use of SOFA and qSOFA scores in managing sepsis 3, 1.

Clinical Judgment

It is essential to note that clinical judgment should always be used in conjunction with these scoring systems, as they are not a replacement for clinical expertise and patient assessment 2. The use of these scoring systems should be tailored to the individual patient and clinical context, taking into account factors such as age, comorbidities, and underlying health conditions.

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 4
• qSOFA score: simpler to use, making it a more suitable tool in an emergency setting, but has lower accuracy than SOFA and LODS scores 4
• LODS score: has higher accuracy than qSOFA score, similar to SOFA score 4

Score Interpretation

• SOFA score:
  • AUC (area under the receiver operating characteristic curve) of 0.75 for predicting in-hospital mortality at the time of emergency department presentation 5
  • AUC of 0.89 for predicting sepsis, with sensitivity and negative predictive values of 100% when the score is >11 6
• qSOFA score:
  • AUC of 0.558 for predicting 28-day prognosis, and 0.551 for predicting 90-day prognosis 4
  • sensitivity of 86.1% and specificity of 56.7% for predicting critical illness 7
• LODS score:
  • AUC of 0.668 for predicting 28-day prognosis, and 0.644 for predicting 90-day prognosis 4

Clinical Implications

• SOFA score, qSOFA score, and △SOFA score are risk factors for the severity and prognosis of patients with sepsis, and have value in diagnosing sepsis and assessing the condition and prognosis 8
• The combined value of SOFA score, qSOFA score, and △SOFA score is higher than each score alone 8