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Prognostic accuracy of SOFA and qSOFA for mortality among children with infection: a meta-analysis

Pediatric Research volume 93, pages 763–771 (2023)Cite this article

Abstract

Background

Age-adjusted Sequential Organ Failure Assessment (SOFA) and age-adjusted quick SOFA (qSOFA) scores have been developed to predict poor outcomes in children with infection. We investigated the prognostic performance of age-adjusted SOFA and age-adjusted qSOFA scores and compared them with the systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in children with infection.

Methods

A bivariate random-effects regression model was used for synthesis of diagnostic test data.

Results

A total of 14 studies invoing 70,194 participants were included. The pooled sensitivity for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.82 (95% CI, 0.74–0.88), 0.46 (95% CI, 0.22–0.71), and 0.79 (95% CI, 0.66–0.88), respectively. The pooled specificity for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.62 (95% CI, 0.45–0.77), 0.90 (95% CI, 0.66–0.98), and 0.39 (95% CI, 0.26–0.54), respectively. The area under the summary receiver operating characteristic curve (AUSROC) for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.82 (95% CI, 0.79–0.85), 0.66 (95% CI, 0.62–0.70), and 0.64 (95% CI, 0.60–0.68), respectively. Different baseline populations, different SOFA adaptation methods and different cut-offs used for age-adjusted SOFA may be potential sources of heterogeneity.

Conclusions

Age adjusted SOFA score is a useful tool for predicting mortality in children with sepsis/suspected sepsis.

Impact

  • First study to investigate the prognostic performance of age-adjusted sequential organ failure assessment (SOFA) and age adjusted quick SOFA (qSOFA) scores in comparison to the systemic inflammatory response criteria (SIRS) for the prediction of mortality in children with sepsis.

  • The age-adjusted SOFA score predicts poor outcomes with high sensitivity in children with sepsis

  • Low sensitivity limits the utility of age-adjusted qSOFA as a simple predictive tool for adverse outcomes. Developing another enhanced or modified bedside tool with higher sensitivity may be necessary.

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Fig. 1: Flow diagram of study inclusion.
Fig. 2: Methodological quality assessment of included studies based on the QUADAS-2 scale.
Fig. 3: Forest plots of sensitivity and specificity.
Fig. 4: Summary receiver operating characteristic (SROC) curves for predicting mortality in children with suspected infection.

Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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Author notes

  1. These authors contributed equally: Zhili Wang, Yu He.

Authors and Affiliations

  1. Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China

    Zhili Wang, Yu He & Zhengxiu Luo

  2. Department of Pediatrics, Jiangjin District Central Hospital, Chongqing, 400014, China

    Xiaolong Zhang

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  2. Yu He
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Contributions

Z.W. is responsible for the conception, data search, data analysis, statistical analyses, data interpretation, writing and revising the manuscript. Y.H. is responsible for inclusion and exclusion of studies, assessment of methodological quality, data extraction, writing and revising the manuscript. X.Z. is responsible for inclusion and exclusion of studies, assessment of methodological quality, data extraction, and statistical analyses. Z.L. is responsible for the supervision and reviewed the manuscript for important intellectual content. All authors approved the manuscript.

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Correspondence to Zhengxiu Luo.

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Wang, Z., He, Y., Zhang, X. et al. Prognostic accuracy of SOFA and qSOFA for mortality among children with infection: a meta-analysis. Pediatr Res 93, 763–771 (2023). https://doi.org/10.1038/s41390-022-02213-6

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  • DOI: https://doi.org/10.1038/s41390-022-02213-6

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