The utility of qSOFA in assessing outcomes of patients with acute heart failure in a level II hospital: a single-center retrospective analysis
Authors: Mercader L , Fortinez J T 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
High all-cause mortality is associated with acute heart failure (AHF) hospitalization, both when the condition first develops and when it worsens. Although there are several risk models for patients with chronic heart failure (CHF), it is unknown whether these scoring systems may be applied to patients with ADHF to predict their chance of developing the condition.

Purpose
Acute Heart failure (AHF) patients benefit from accurate risk assessment. Those stratified with worse prognosis may benefit more from continuous and close monitoring, with subsequent prompt intervention in case of deterioration. Currently, there is a lack of a universally accepted risk score that can accurately predict outcomes in acute heart failure (AHF). Undeniably, sepsis and AHF share several clinical features. These similarities encourage the sepsis-to-AHF translation of SOFA and qSOFA scores. We compared different scoring systems used in sepsis and assessed their predictive accuracy.

Methodology
This retrospective study included all patients with acute heart failure admitted in a private teaching hospital between January 2014 and January 2023. This study included newly admitted adult patients with new-onset AHF or acute on chronic heart failure. Baseline qSOFA, SIRS, and SOFA values were determined. Receiver Operating Characteristics - Area under the Curve (ROC-AUC) analysis assessed these scores' ability to predict mortality, whereas chi-square and Fischer's exact test assessed secondary outcome risk.

Results
545 patients were included in the study. The majority were males with a mean age of 65 years. Most patients in the study required oxygen support, were classified as NOHRIA A, and with NYHA Functional Class II. Renal and respiratory failures were prominent upon arrival. About 11% met ≥2 points in qSOFA. Therein, systolic BP of &lt;100 mmHg was the most frequent criterion met. The primary endpoint, that is in-hospital mortality, occurred in 9.52% of patients. A positive qSOFA, defined as a score of 2 or more, was consistent in the majority of those meeting the primary endpoint (Chi2 = 264.698, p&lt;0.001). The ROC analysis of qSOFA (AUC 0.949, 95% CI 0.924–0.974, accuracy of 73%), SOFA (AUC 0.935, 95% CI 0.887–0.983, accuracy of 72%), and SIRS criteria (AUC 0.939, 95% CI 0.917–0.961, accuracy of 72%) show no fundamental differences regarding the prediction of the primary endpoint. Patients with positive qSOFA criteria were more frequently affected by organ failure (OR 5.386, p &lt;0.001), needed more vasopressors (OR 4.921, p &lt; 0.001), notably with an ejection fraction &lt;40% (OR 3.363, p &lt;0.001), and required mechanical ventilator support more often (OR 3.794, p&lt;0.001).

Conclusion
In conclusion, qSOFA used in Acute Heart Failure is a valuable tool in the early detection of in-hospital mortality and detection of worse outcomes, hence should be considered when making therapeutic strategies and decisions.AUC for Primary OutcomesSecondary Outcomes