A Comparative Study between SIRS, QSOFA, NEWS AND MEWS Score as Predictors for Inhospital Mortality of Patients Getting Admitted To ICU of a Tertiary Care Teaching Hospital

Abstract

Sepsis screening in the Emergency Department (ED) is necessary for the rational management of patients. Multiple severity screening scores such as Systemic Inflammatory Response Syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), and the Modified Early Warning Score (MEWS) are available. Though "Sepsis-3" recommends the use of the qSOFA score. This study seeks to validate each of these scores in a critical care setting and identify the score with the greatest predictive value for in hospital mortality. This comparative study included 188 patients determined to have sepsis. The information required for calculating SIRS, qSOFA, NEWS, and MEWS was extracted with careful history taking, patient assessment, and necessary investigations. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver-operating characteristic (AUROC) for each scoring system were measured for Intensive Care Unit (ICU) mortality. qSOFA had the highest specificity (73.61%) and the lowest sensitivity (36.02%). SIRS and NEWS scores had the highest sensitivity (77.78%) while SIRS had the lowest specificity (23.88%). The NEWS score had a specificity of 41.79%. MEWS score had an intermediate sensitivity of 76.36% and specificity of 63.91%. The ability to predict ICU mortality was highest for MEWS≥5 score (AUC 0.76; 95 % CI 0.68-0.84) compared to NEWS≥5 (AUC 0.61; 95% CI 0.52-0.71), qSOFA≥2 (AUC 0.56; 95% CI 0.46-0.66), and SIRS≥2 (AUC 0.49; 95% CI 0.37-0.61). By comparing HSROC curves, the MEWS score showed higher overall prognostic accuracy than SIRS, qSOFA and NEWS. Among qSOFA, SIRS, NEWS, and MEWS, the MEWS score showed the highest overall prognostic accuracy. However, no scoring system showed both high sensitivity and specificity for predicting the accuracy of mortality in patients with sepsis.