• Shigeki Kushimoto, Satoshi Gando, Hiroshi Ogura, Yutaka Umemura, Daizoh Saitoh, Toshihiko Mayumi, Seitaro Fujishima, Toshikazu Abe, Atsushi Shiraishi, Hiroto Ikeda, Joji Kotani, Yasuo Miki, Shin-Ichiro Shiraishi, Koichiro Suzuki, Yasushi Suzuki, Naoshi Takeyama, Kiyotsugu Takuma, Ryosuke Tsuruta, Yoshihiro Yamaguchi, Norio Yamashita, and Naoki Aikawa.
• Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Aoba-ku, Miyagi, Japan.
• J Intensive Care Med. 2020 May 1; 35 (5): 502-510.

BackgroundAlthough the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia.MethodsPatients with severe sepsis admitted to intensive care units (ICUs) were retrospectively analyzed. The predictive validities of qSOFA (≥2, positive) and the complementary effect of hypothermia (body temperature ≤36.5°C) for the identification of death or multiorgan dysfunction were evaluated.ResultsOf the 624 patients, 230 (36.9%) developed multiorgan dysfunction and 144 (23.1%) died within 28 days; 527 (84.5%) had a positive qSOFA. The 28-day mortality rates of patients with positive and negative qSOFA were 25.4% and 10.3%, respectively (P = .001). The rate of positive qSOFA was higher in patients with multiorgan dysfunction (sensitivity, 0.896; specificity, 0.185) and among patients who died within 28 days (sensitivity, 0.931; specificity, 0.181); 10 (6.9%) of 144 deaths were not identified. In cases of positive qSOFA without hypothermia, positive qSOFA + hypothermia, or negative qSOFA with hypothermia, the predictive value for 28-day mortality improved (sensitivity, 0.979). Among the 144 patients who died, only 3 were not identified.ConclusionA qSOFA score ≥2 may identify >90% of 28-day deaths among patients with severe sepsis; hypothermia may complement the predictive ability of qSOFA.

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