Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review
Abstract Background and Aims Infections are common in hospitals, and if mismanaged can develop into sepsis, a leading cause of death and disability worldwide. This study aimed to examine whether combining C‐reactive protein (CRP) with the quick sequential organ failure assessment (qSOFA) improves it...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | Health Science Reports |
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| Online Access: | https://doi.org/10.1002/hsr2.1229 |
| _version_ | 1827960061303980032 |
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| author | Alexandra Zacharakis Khalia Ackermann Clifford Hughes Vincent Lam Ling Li |
| author_facet | Alexandra Zacharakis Khalia Ackermann Clifford Hughes Vincent Lam Ling Li |
| author_sort | Alexandra Zacharakis |
| collection | DOAJ |
| description | Abstract Background and Aims Infections are common in hospitals, and if mismanaged can develop into sepsis, a leading cause of death and disability worldwide. This study aimed to examine whether combining C‐reactive protein (CRP) with the quick sequential organ failure assessment (qSOFA) improves its accuracy for predicting mortality and sepsis in adult inpatients. Methods PubMed, MEDLINE, EMBASE, Scopus, Web of Science, Science Direct, CINAHL, Open Grey, Grey Literature Report, and the Clinical Trials registry were searched using CRP and qSOFA search terms. Title, abstract, and full‐text screening were performed by two independent reviewers using pre‐determined eligibility criteria, followed by data extraction and a risk of bias assessment using the Quality Assessment tool for Diagnostic Accuracy Studies 2 (QUADAS‐2). Disagreements were settled through discussion and consultation with a third reviewer. Results Four retrospective studies with a total of 2070 patients were included in this review. Adding CRP to qSOFA improved the Area Under the Receiver Operating Characteristic Curve up to 9.7% for predicting mortality and by 14.9% for identifying sepsis. The sensitivity and specificity of the combined score for mortality prediction were available in two studies. CRP improved the sensitivity of qSOFA by 43% and 71% while only decreasing the specificity by 12% and 7%, respectively. A meta‐analysis was not performed due to study heterogeneity. Conclusion This comprehensive review provided initial evidence that combining CRP with qSOFA may improve the accuracy of qSOFA alone in identifying sepsis or patients at risk of dying in hospital. The combined tool demonstrated the potential to improve patient outcomes, with implications for low‐resource settings given its simplicity and low‐cost. |
| first_indexed | 2024-04-09T16:02:37Z |
| format | Article |
| id | doaj.art-24d64e8b470745f19ea8d12f3cf15a49 |
| institution | Directory Open Access Journal |
| issn | 2398-8835 |
| language | English |
| last_indexed | 2024-04-09T16:02:37Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Health Science Reports |
| spelling | doaj.art-24d64e8b470745f19ea8d12f3cf15a492023-04-25T08:04:34ZengWileyHealth Science Reports2398-88352023-04-0164n/an/a10.1002/hsr2.1229Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic reviewAlexandra Zacharakis0Khalia Ackermann1Clifford Hughes2Vincent Lam3Ling Li4Macquarie Medical School, Faculty of Medicine, Health and Human Sciences Macquarie University Sydney New South Wales AustraliaAustralian Institute of Health Innovation Macquarie University Sydney New South Wales AustraliaMacquarie Medical School, Faculty of Medicine, Health and Human Sciences Macquarie University Sydney New South Wales AustraliaMacquarie Medical School, Faculty of Medicine, Health and Human Sciences Macquarie University Sydney New South Wales AustraliaAustralian Institute of Health Innovation Macquarie University Sydney New South Wales AustraliaAbstract Background and Aims Infections are common in hospitals, and if mismanaged can develop into sepsis, a leading cause of death and disability worldwide. This study aimed to examine whether combining C‐reactive protein (CRP) with the quick sequential organ failure assessment (qSOFA) improves its accuracy for predicting mortality and sepsis in adult inpatients. Methods PubMed, MEDLINE, EMBASE, Scopus, Web of Science, Science Direct, CINAHL, Open Grey, Grey Literature Report, and the Clinical Trials registry were searched using CRP and qSOFA search terms. Title, abstract, and full‐text screening were performed by two independent reviewers using pre‐determined eligibility criteria, followed by data extraction and a risk of bias assessment using the Quality Assessment tool for Diagnostic Accuracy Studies 2 (QUADAS‐2). Disagreements were settled through discussion and consultation with a third reviewer. Results Four retrospective studies with a total of 2070 patients were included in this review. Adding CRP to qSOFA improved the Area Under the Receiver Operating Characteristic Curve up to 9.7% for predicting mortality and by 14.9% for identifying sepsis. The sensitivity and specificity of the combined score for mortality prediction were available in two studies. CRP improved the sensitivity of qSOFA by 43% and 71% while only decreasing the specificity by 12% and 7%, respectively. A meta‐analysis was not performed due to study heterogeneity. Conclusion This comprehensive review provided initial evidence that combining CRP with qSOFA may improve the accuracy of qSOFA alone in identifying sepsis or patients at risk of dying in hospital. The combined tool demonstrated the potential to improve patient outcomes, with implications for low‐resource settings given its simplicity and low‐cost.https://doi.org/10.1002/hsr2.1229C‐reactive proteinearly diagnosishospital mortalityinfectionsorgan dysfunction scoressepsis |
| spellingShingle | Alexandra Zacharakis Khalia Ackermann Clifford Hughes Vincent Lam Ling Li Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review Health Science Reports C‐reactive protein early diagnosis hospital mortality infections organ dysfunction scores sepsis |
| title | Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review |
| title_full | Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review |
| title_fullStr | Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review |
| title_full_unstemmed | Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review |
| title_short | Combining C‐reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review |
| title_sort | combining c reactive protein and quick sequential organ failure assessment qsofa to improve prognostic accuracy for sepsis and mortality in adult inpatients a systematic review |
| topic | C‐reactive protein early diagnosis hospital mortality infections organ dysfunction scores sepsis |
| url | https://doi.org/10.1002/hsr2.1229 |
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