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Which rating system is better – qSOFA or SIRS?

Pavlina Peneva, Silviya P Nikolova, Yana Bocheva



The definitions of sepsis and septic shock were redefined in 2016. This study compares the performance of qSOFA with that of SIRS criteria for the diagnosis of sepsis and prediction of 30-day mortality.


The aim of this article is to assess the severity of the infection of patients using SIRS and qSOFA scales and to compare their specificity and predictive value.


Materials and Methods

A prospective, non-interventional single-center clinical trial was conducted at St. Marina University Hospital in Varna. The sample included 87 patients with sepsis and septic shock. The criteria for inclusion in the study were laboratory constellation for systemic exposure; over 18 years of age; with or without co-morbidities; no malignancies. Pregnancy, neoplasia and the age of under 18 were the criteria for exclusion. Logistic regression was used to test the predictability of both scales. ROC curve analysis determined the sensitivity and specificity of SIRS and qSOFA.


Our analysis showed that both SIRS and qSOFA are significant predictors of mortality of septic patients. The SIRS scale had a 2.050-fold probability of predicting the death of the patient (p = 0.004, 95% CI 1.255 - 3.349), whereas the qSOFA score was 2.581 times more likely to predict mortality in patients with sepsis and septic shock (p = 0.0001, 95% CI 1.557 - 4.279). Cut-off values for SIRS higher than 2.5 points showed 91% sensitivity and  60% specificity - (AUC 0.80, 95% CI - 0.712 - 0.907), whereas qSOFA scores greater than 1.5 points indicated sensitivity of 82.2% and  specificity of 70.3% (AUC 0.85, 95% CI 0 0.770 - 0.934).



SIRS and qSOFA criteria for early detection of sepsis are useful clinical tools for mortality reduction and predictability.




SIRS, qSOFA, infection, sepsis, mortality, predictability

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Beesley S, Lanspa M. Why we need a new definition of sepsis. Ann Transl Med. 2015;3(19):296. doi: 10.3978/j.issn.2305-5839.2015.11.02.

Berger R, Rivers E, Levy MM. Management of septic shock. N Engl J Med. 2017; 376(23):2282-5.doi: 10.1056/NEJMclde1705277.

Blanco J, Muriel-Bombín A, Sagredo V, Taboada F, Gandía F, Tamayo L, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care. 2008. 12(6):R158. doi: 10.1186/cc7157.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31(4):1250-6. doi: 10.1097/01.CCM.0000050454.01978.3B.

Shankar-Hari M, Deutschman CS, et al. Assessment of definition and clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016. 315(8):801-810. doi:10.1001/jama.2016.02

Arabi YM, Dara SI, Tamim HM, Rishu AH, Bouchama A, Khedr MK, et al. Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Crit Care. 2013; 17(2):R72. doi: 10.1186/cc12680.

Jiang J, YangY, Jing Mei J, Jin Y, Lu Y. Head-to-head comparison of qSOFA and SIRS criteria in predicting the mortality of infected patients in the emergency department: a meta-analysis. Scand J Trauma Resusc Emerg Med. 2018; 26(1):56. doi: 10.1186/s13049-018-0527-9

Raith E, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, et al, Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection, admitted to the intensive care unit. JAMA; 2017;317(3):290-300. doi:10.1001/jama.2016.20328.

Usman OA, Usman AA, Ward MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in emergency department. Am J Emerg Med. 2019 Aug;37(8):1490-1497. doi: 10.1016/j.ajem.2018.10.058.

Vincent JL, Martin GS, Levy MM. qSOFA does not replace SIRS in the definition of sepsis. Crit Care. 2016;20(1):210. doi: 10.1186/s13054-016-1389-z.

Khwannimit B, Bhurayanontachai R, Vattanavanit V. Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. J Crit Care. 2018; 44:156-60. doi: 10.1016/j.jcrc.2017.10.023

Goulden R, Hoyle MC, Monis J, Railton D, Riley V, Martin P, et al. qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. BMJ. 2018 ;35(6):345-349. doi: 10.1136/emermed-2017-207120.

Haydar S, Spanier M, Weems P, Wood S, Strout T. Comparison of qSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis, AJEM. 2017;35(11):1730-3. doi: 10.1016/j.ajem.2017.07.001.

Serafim R, Gomes JA, Salluh J, Póvoa P. A comparison of the quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of sepsis and prediction of mortality: a systematic review and meta-analysis. Chest. 2018;153(3):646-55. doi: 10.1016/j.chest.2017.12.015.

Bone R. Sir Isaac Newton, sepsis, SIRS and CARS. Crit Care Med. 1996; 24(7):1125-28. doi: 10.1097/00003246-199607000-00010.

Deis А, Whiles B, Simpson S. SIRS vs qSOFA at presentation in patients with diagnosed severe sepsis and septic shock. Chest. 2016;150(4_S):348A. doi: 10.1016/j.chest.2016.08.361.

Franchini S, Scarallo L, Carlucci M, Cabrini L, Tresoldi M. SIRS or qSOFA? Is that the question? Clinical and methodological observations from a meta-analysis and critical review on the prognostication of patients with suspected sepsis outside the ICU. Intern Emerg Med. 2019;4(4):593-602. doi: 10.1007/s11739-018-1965-0.

Kalil А, Bailey KL. Septic Shock, 2018. Available from:

Kostadinova V, Miteva D, Radkov Y, Mircheva I. In-hospital mortality risk assessment in patients with community acquired pneumonia. Eur Respir J. 2014;44 (Suppl 58): P2479.

Reinhart K, Daniels R, Kissoon N, Machado FR, Schachter RD, Finfer S . Recognizing sepsis as a global health priority — a WHO resolution, N Engl J Med. 2017;377(5):414-7. doi: 10.1056/NEJMp1707170.

Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762–74. doi: 10.1001/jama.2016.0288.

Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, еt al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998 Nov;26(11):1793-800. doi: 10.1097/00003246-199811000-00016.

Miteva D, Kostadinova V, Radkov Y, Mircheva I . Comparison of the prognostic value of different severity scales in community-acquired pneumonia. Eur Respir J. 2014; 44 (Suppl 58): PA 2477.



About The Authors

Pavlina Peneva
Medical University of Varna

Clinic of Pneumology аnd Phthisiatry, St. Marina University Hospital

Silviya P Nikolova
Medical University of Varna

Department of Social Medicine and Healthcare Organization, Faculty of Public Health

Yana Bocheva
Medical University of Varna

Department of Clinical Laboratory and Immunology, St. Marina University Hospital

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