SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis

We compared Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Quick Sepsis-related Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) for sepsis diagnosis and adverse outcomes prediction. Clinical studies that used SIRS, SOFA, qSOFA, and NEWS for sepsis diagnosis and prognosis assessment were included. Data were extracted, and meta-analysis was performed for outcome measures, including sepsis diagnosis, in-hospital mortality, 7/10/14-day mortality, 28/30-day mortality, and ICU admission. Fifty-seven included studies showed good overall quality. Regarding sepsis prediction, SIRS demonstrated high sensitivity (0.85) but low specificity (0.41), qSOFA showed low sensitivity (0.42) but high specificity (0.98), and NEWS exhibited high sensitivity (0.71) and specificity (0.85). For predicting in-hospital mortality, SOFA demonstrated the highest sensitivity (0.89) and specificity (0.69). In terms of predicting 7/10/14-day mortality, SIRS exhibited high sensitivity (0.87), while qSOFA had high specificity (0.75). For predicting 28/30-day mortality, SOFA showed high sensitivity (0.97) but low specificity (0.14), whereas qSOFA displayed low sensitivity (0.41) but high specificity (0.88). NEWS independently demonstrates good diagnostic capability for sepsis, especially in high-income countries. SOFA emerges as the optimal choice for predicting in-hospital mortality and can be employed as a screening tool for 28/30-day mortality in low-income countries.

本研究对比了全身炎症反应综合征（Systemic Inflammatory Response Syndrome, SIRS）、序贯器官衰竭评分（Sequential Organ Failure Assessment, SOFA）、快速脓毒症相关器官衰竭评分（Quick Sepsis-related Organ Failure Assessment, qSOFA）以及国家早期预警评分（National Early Warning Score, NEWS）在脓毒症诊断与不良结局预测中的应用价值。纳入采用SIRS、SOFA、qSOFA及NEWS开展脓毒症诊断与预后评估的临床研究，提取相关数据并针对包括脓毒症诊断、住院死亡率、7/10/14天死亡率、28/30天死亡率以及ICU收治情况在内的结局指标进行Meta分析。纳入的57项研究整体质量良好。在脓毒症预测方面，SIRS展现出高灵敏度（0.85）但低特异度（0.41）；qSOFA灵敏度较低（0.42）但特异度较高（0.98）；NEWS则兼具较高的灵敏度（0.71）与特异度（0.85）。在住院死亡率预测方面，SOFA的灵敏度（0.89）与特异度（0.69）均为最高。针对7/10/14天死亡率预测，SIRS灵敏度较高（0.87），而qSOFA的特异度较高（0.75）。对于28/30天死亡率预测，SOFA灵敏度较高（0.97）但特异度较低（0.14），而qSOFA灵敏度较低（0.41）但特异度较高（0.88）。NEWS在脓毒症诊断中具备良好的独立诊断能力，尤其在高收入国家中表现突出。SOFA是预测住院死亡率的最优选择，同时可作为低收入国家28/30天死亡率的筛查工具。