Vincent JL, Martin GS and Levy MM recently wrote an article in Critical Care entitled “qSOFA does not replace SIRS in the definition of sepsis” [1]. In this paper they specified that “the qSOFA is meant to be used to raise suspicion of sepsis and prompt further action but it is not a replacement for SIRS and is not part of the definition of sepsis”.
One of the starting points that induced the Sepsis-3 consensus taskforce to set out in search of better entry criteria than the systemic inflammatory response syndrome (SIRS) criteria was precisely that SIRS criteria perform poorly on both “discriminant validity” and “convergent validity”[2]. In order to accomplish their task, they identified patients with suspected infection among 1.3 million health record cases and, after comparing the performance of several different clinical criteria, they came out with the quick sequential organ failure assessment (qSOFA) score, whose predictive validity for in-hospital mortality outside the ICU was statistically better than SIRS [3].
The fact that nonspecific SIRS criteria will “generally” continue to aid in the identification and diagnosis of infection was repeatedly affirmed in the Sepsis-3 consensus article [2]. Besides, when the SIRS criteria were first proposed as a screening tool for sepsis [4], they were meant to be applied to patients with “suspected infection”, just as the qSOFA is intended to be used now. However, while the SIRS criteria were essentially based only on expert-consensus [4], the qSOFA criteria were identified through large multivariate statistics and confirmatory analyses, where they proved to perform better than the SIRS criteria [3].
The qSOFA was derived and conceived on the basis of retrospective data, and thus, from now on, the clinical research should and will work hard to prospectively validate the soundness of this tool, in terms of its screening capacity. However, based at least on the currently available evidence, we believe that, although qSOFA does not replace SIRS in the definition of sepsis, it should indeed replace SIRS as the screening tool for sepsis.
We would like to know if Vincent and colleagues agree with this assumption, and we would also like to ask them if, after the Sepsis-3 consensus definitions, the SIRS criteria still retain a real operative role in the process of defining and/or screening sepsis or if they could be, at least operatively, dismissed.
Acknowledgements
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The authors certify that no funding has been received for the conception and writing of this article.
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Authors’ contributions
SF was responsible for conception of the letter, and drafted and revised the manuscript. AD conceived the letter and helped to draft the manuscript. All authors read and approved the final manuscript.
Authors’ information
Both SF and AD are emergency physicians working full-time in the Emergency Department and are involved in their institution’s teaching program regarding sepsis for physicians and nurses.
Competing interests
The authors declare that they have no competing interest.
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Abbreviations
- qSOFA
quick sequential organ failure assessment
- SIRS
systemic inflammatory response syndrome
Footnotes
See related research by Vincent et al., https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1389-z
Contributor Information
Stefano Franchini, Phone: 00390226435638, Email: franchini.stefano@hsr.it.
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References
- 1.Vincent JL, Martin GS, Levy MM. qSOFA does not replace SIRS in the definition of sepsis. Crit Care. 2016;20:210. doi: 10.1186/s13054-016-1389-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315:801–10. doi: 10.1001/jama.2016.0287. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.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;315:762–74. doi: 10.1001/jama.2016.0288. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–55. doi: 10.1378/chest.101.6.1644. [DOI] [PubMed] [Google Scholar]
- 5.Vincent JL, Mira JP, Antonelli M. Sepsis: older and newer concepts. Lancet Respir Med. 2016;4:237–40. [DOI] [PubMed]