COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Clinical Prediction Guide Liu S, Yao N, Qiu Y, et al. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med. 2020 Oct;38(10):2074-2080. doi: 10.1016/j.ajem.2020.07.019. Epub 2020 Jul 12.

OBJECTIVES: The assessment of illness severity at admission can contribute to decreased mortality in patients with the coronavirus disease (COVID-19). This study was conducted to evaluate the effectiveness of the Sequential Organ Failure Assessment (SOFA) and Quick Sequential Organ Failure Assessment (qSOFA) scoring systems at admission for the prediction of mortality risk in COVID-19 patients.

METHODS: We included 140 critically ill COVID-19 patients. Data on demographics, clinical characteristics, and laboratory findings at admission were used to calculate SOFA and qSOFA against the in-hospital outcomes (survival or death) that were ascertained from the medical records. The predictive accuracy of both scoring systems was evaluated by the receiver operating characteristic (ROC) curve analysis.

RESULTS: The area under the ROC curve for SOFA in predicting mortality was 0.890 (95% CI: 0.826-0.955), which was higher than that of qSOFA (0.742, 95% CI 0.657-0.816). An optimal cutoff of =3 for SOFA had sensitivity, specificity, positive predictive value, and negative predictive value of 90.00%, 83.18%, 50.00%, and 97.80%, respectively.

CONCLUSIONS: This novel report indicates that SOFA could function as an effective adjunctive risk-stratification tool at admission for critical COVID-19 patients. The performance of qSOFA is accepted but inferior to that of SOFA.

Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Emergency Medicine
Comments from MORE raters

Emergency Medicine rater

This information is significantly limited by a small sample size and cases obtained in a single centre.

Emergency Medicine rater

This retrospective study sought to evaluate the effectiveness of the SOFA and qSOFA scoring systems to predict mortality in COVID-19. The authors included 127 patients, finding the ROC curve to be 0.890 (95% CI 0.826-0.955) for SOFA and 0.742 (95% CI 0.657-0.816) for qSOFA. A SOFA of 3 or higher had a sensitivity and specificity of 90% and 83.2% for predicting mortality. However, there is little discussion in the methods of the techniques utilized in obtaining and assessing the data from the chart review. We do not know how many investigators abstracted the data, were blinded/trained, and whether a kappa was calculated for their abstraction. The authors also do not specify what type of clinical manifestations or laboratory tests were available in patient records. The sample size is a limitation, and it was conducted at a single center. Further prospective validation is required, though SOFA may be more accurate in predicting mortality when compared to qSOFA based on this one study.

Hospital Doctor/Hospitalists rater

The SOFA score did not perform well enough to impact clinical practice, and it contains information that most clinicians should know impacts patient outcomes. It misses many variables that also predict patient outcome not included in the score. It is too nonspecific to change practice.