Internal and Emergency Medicine

, Volume 14, Issue 4, pp 593–602 | Cite as

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

  • Stefano FranchiniEmail author
  • Luca Scarallo
  • Michele Carlucci
  • Luca Cabrini
  • Moreno Tresoldi


The purpose of the study was to assess the prognostic performances, in terms of in-hospital mortality, of the quick sequential organ failure assessment (qSOFA) score and the systemic inflammatory response syndrome (SIRS) criteria applied to patients with suspected infection outside the ICU, and to critically reappraise the results and the clinical impact of the SEPSIS-3 study and of the subsequent trials. We performed bivariate meta-analysis, evaluation of the Bayesian post-test probabilities of death, and computation of the unidentified deaths for every 1000 screened cases (UDS1000). The use of qSOFA for screening instead of the SIRS implies a relevant increase in the UDS1000. However, this difference appears far smaller in the SEPSIS-3 study, largely due to an underestimation of SIRS sensitivity. The increment in the pre-test probability of death implied by a positive qSOFA is higher than that implied by a positivity of the SIRS. However, the included studies use highly variable definitions of “suspected sepsis” and carry very high levels of heterogeneity. SIRS overperforms qSOFA as a rule-out tool for mortality, while qSOFA shows a higher rule-in power. However, the evident lack of consistency across the published studies undermines the significance of both the meta-analytic approach and the reproducibility of the outcomes, and demands for a standardized definition of the target population.


qSOFA SIRS Sepsis screening Sepsis prognosis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animal performed by any of the authors.

Informed consent:


Supplementary material

11739_2018_1965_MOESM1_ESM.pdf (357 kb)
Supplementary material 1 (PDF 356 kb)


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Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  • Stefano Franchini
    • 1
    Email author
  • Luca Scarallo
    • 2
  • Michele Carlucci
    • 1
    • 3
  • Luca Cabrini
    • 4
  • Moreno Tresoldi
    • 5
  1. 1.Emergency DepartmentOspedale San Raffaele Scientific Institute, Pronto SoccorsoMilanItaly
  2. 2.Faculty of MedicineVita-Salute San Raffaele UniversityMilanItaly
  3. 3.Department of General and Emergency SurgeryOspedale San Raffaele Scientific InstituteMilanItaly
  4. 4.Department of Anaesthesia and Intensive CareOspedale San Raffaele Scientific InstituteMilanItaly
  5. 5.Unit of General Medicine and Advanced CareOspedale San Raffaele Scientific InstituteMilanItaly

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