Background: The quick Sequential Organ Failure Assessment (qSOFA) score was introduced by Sepsis-3 or the Third In-ternational Consensus Definitions for Sepsis and Septic Shock to help physicians in identifying patients outside the intensive care unit with suspected infection who are at high risk for in-hospital mortality. However, sepsis is not a homogenous entity and the outcomes vary based on several factors. This study aimed to determine the predictive accuracy of qSOFA in iden-tifying those at high-risk of in-hospital mortality among adult patients with sepsis secondary to urinary tract infection.

Methodology: A retrospective cohort study was done involving the use of qSOFA score to predict in-hospital mortality of adult patients with a diagnosis of sepsis secondary to urinary tract infection, admitted in the hospital from January 1, 2013 to December 31, 2020. qSOFA is computed based on the following independent variables: systolic blood pressure (SBP), respiratory rate (RR), and Glasgow Coma Scale (GCS).

Results: Of the 128 charts retrieved, 121 patients were included in the study. Fifteen (12.40%) died while 106 (87.60%) survived. Mean age was 60.76 years old, with more females (71.90%) than males (28.10%). Hypertension and Diabetes Mellitus Type 2 were the most frequent comorbidities. Complicated UTI was the most frequent source of infection. Mean length of stay was 8.29 days. Forty (33.06%) patients had qSOFA ≥ 2 wherein 11 (27.5%) died. Diagnostic performance results revealed: sensitivity (73.33%), specificity (72.64%), positive (27.5%) and negative (95.06%) predictive values, and positive (2.68) and negative (0.37) likelihood ratios. qSOFA accuracy was 72.73% with an AUROC of 0.76.

Conclusion: Among the admitted adult patients with sepsis secondary to a UTI, qSOFA had a good prognostic accuracy for in-hospital mortality.

Keywords: qSOFA, sepsis, UTI, urinary tract infection, in-hospital mortality

1. Dugar, S., Choudhary, C., & Duggal, A. (2020, January 01). Sepsis and septic shock: Guideline-based management. Re-trieved October 12, 2020, from https://www.ccjm.org/con-tent/87/1/53
2. Medlej, K. (Ed.). (2018, October). QSOFA (Quick SOFA) Score for Sepsis. Retrieved October 12, 2020, from https://www.eb-medicine.net/media_library/files/Calculated%20Deci-sions%20E018%20Sepsis.pdf
3. Scala, R., Schultz, M., Bos, L. D., & Artigas, A. (2018, July 01). New Surviving Sepsis Campaign guidelines: Back to the art of medicine. Retrieved October 12, 2020, from https://erj.ersjour-nals.com/content/52/1/1701818
4. Jameson, J., Kasper, D. L., Longo, D. L., Fauci, A. S., Hauser, S. L., & Loscalzo, J. (Eds.). (2018). Harrison's Principles of In-ternal Medicine (20th ed.). New York City: McGraw-Hill Educa-tion.
5. Seymour, C. W., Liu, V. X., Iwashyna, T. J., Brunkhorst, F. M., Rea, T. D., Scherag, A., Angus, D. C. (2016). Assessment of Clinical Criteria for Sepsis. JAMA,315(8), 762-774. doi:10.1001/jama.2016.0288
6. Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Angus, D. C. (2016). The Third In-ternational Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Journal of the American Medical Association,315(8), 801-810. doi:10.1001/jama.2010287
7. Fernando, S. M., Tran, A., Taljaard, M., Cheng, W., Rochwerg, B., Seely, A. J., & Perry, J. J. (2018). Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Pa-tients with Suspected Infection: A Systematic Review and Meta-analysis [Abstract]. Annals of Internal Medicine,168(4), 266-275. doi: https://doi.org/10.7326/M17-2820
8. Giamarellos-Bourboulis, E., Tsaganos, T., Tsangaris, I., Lada, M., Routsi, C., Sinapidis, D., Gogos, C. (2017). Validation of the new Sepsis-3 definitions: Proposal for improvement in early risk identification. Clinical Microbiology and Infection,23(2), 104-109. doi: 10.1016/j.cmi.2016.11.003
9. Freund, Y. V., Lemachatti, N. V., Krastinova, E. V., Laer, M. V., Claessens, Y. V., Avondo, A. V. (2017). Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients with Suspected Infection Presenting to the Emergency Depart-ment. The Journal of the American Medical Association,317(3), 301. doi:10.1001/jama.2016.20329
10. Ang, S. C., Ubaldo, O. V., Raymundo-Tayzon, M., Abad, C. R., Henson, K. R., Gueco, I. P., & Cinco, J. L. (2018). Prospective cohort study of the qSOFA score versus the SIRS criteria in the determination and prognostication of sepsis in Philippines ter-tiary hospital [Abstract]. Journal of Infectious Diseases & Ther-apy 5:7(Suppl) doi:4172/2332-0877-C6-054
11. Abe, T., Ogura, H., Kushimoto, S., Shiraishi, A., Sugiyama, T., Deshpande, G. A., . . . Gando, S. (2019). Variations in infection sites and mortality rates among patients in intensive care units with severe sepsis and septic shock in Japan. Journal of Inten-sive Care,7(1). doi:10.1186/s40560-019-0383-3
12. Akinosoglou, K., & Gogos, C. (2017, September 11). Sepsis-3 in Community acquired Pneumonia: How Reliable Is It? [Letter written September 11, 2017]. Retrieved February 24, 2021, from https://www.atsjour-nals.org/doi/pdf/10.1164/rccm.201707-1414LE
13. The World Bank of the Philippines (2020, October 16). Philip-pines Overview. Retrieved October 31, 2020, from https://www.worldbank.org/en/country/philippines/overview
14. Glen, S. (2021, January 12). Sample Size in Statistics (How to Find it): Excel, Cochran's Formula, General Tips. Retrieved May 6, 2021, from https://www.statisticshowto.com/probability-and-statistics/find-sample-size/
15. Eliakim-Raz, N., Babitch, T., Shaw, E., Addy, I., Wiegand, I., Vank, C., Pujol, M. (2018). Risk Factors for Treatment Failure and Mortality among Hospitalised Patients with Complicated Uri-nary Tract Infection: A Multicentre Retrospective Cohort Study, RESCUING Study Group. Clinical Infectious Diseases,68(1), 29-36. doi :10.1093/cid/ciy418
16. Qiang, X., Yu, T., Li, Y., & Zhou, L. (2016). Prognosis Risk of Urosepsis in Critical Care Medicine: A Prospective Observa-tional Study. BioMed Research International, 2016, 1-5. doi:10.1155/2016/9028924
17. Pandey, S., Sankhwar, S. N., Goel, A., Kumar, M., Aggarwal, A., Sharma, D., Pandey, T. (2019). Quick Sequential (Sepsis re-lated) Organ Failure Assessment: A high-performance rapid prognostication tool in patients having acute pyelonephritis with upper urinary tract calculi. Investigative and Clinical Urol-ogy,60(2), 120. doi:10.4111/icu.2019.60.2.120
18. Jiang, J., Yang, J., Jin, Y., Cao, J., & Lu, Y. (2018). Role of qSOFA in predicting mortality of pneumonia. Medicine,97(40). doi:10.1097/md.0000000000012634