Clin Microbiol Infect. 2020 Oct 10:S1198-743X(20)30619-4. doi: 10.1016/j.cmi.2020.10.008. Online ahead of print.
OBJECTIVE: The qSOFA score shows similarities to the CRB-65 pneumonia score, but its prognostic accuracy in patients with community-acquired pneumonia (CAP) has not been extensively evaluated. The aim was to validate the qSOFA(-65) score in a large cohort of CAP patients.
METHODS: We conducted a retrospective population-based cohort study including all cases with CAP hospitalized between 01/01/2014 and 31/12/2018 from the German nationwide mandatory quality assurance program. We excluded cases transferred from another hospital, with mechanical ventilation (MV) present on admission, and without documented respiratory rate. Predefined outcomes were hospital mortality and need of MV.
RESULTS: Among the 1,262,250 included cases hospital mortality was 12.4% and MV rate 7.1%. All CRB and qSOFA criteria were associated with both outcomes, but the qSOFA had inferior sensitivity compared to the CRB-65 for mortality prediction. Including the age criterion ≥65 years, qSOFA-65 and CRB-65 performed similarly (AUC 0.69 [95% CI 0.69-0.69] versus 0.68 [95% CI 0.68-0.68]). A qSOFA-65 of 0 was associated with fewer missed deaths (3,328, 2.0%) compared to a CRB-65 of 0 (5,480, 2.4%). The sensitivity of the suggested qSOFA cut-off of ≥2 for sepsis was low (mortality: 25.8% [95% CI 25.6%-26.0%], MV: 24.1% [95% CI 23.8%-24.4%]). Results were similar when excluding frail and palliative patients.
CONCLUSIONS: The qSOFA parameters show prognostic accuracy similar to the CRB parameters in CAP, but the sepsis cut-off of ≥2 lacked sensitivity. For sensitive mortality prediction, the age criterion ≥65 years should be added to the qSOFA.