Utility of SIRS criteria and QSOFA score in identifying patients with central nervous system infections at risk for poor outcome

Several scoring methods have been developed to identify critically ill patients with suspected sepsis who may benefit from intensive care treatment. We studied the prognostic value of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential related Organ Failure Assessmen...

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Bibliographic Details
Published in:Scientific reports Vol. 15; no. 1; pp. 37447 - 8
Main Authors: Resok, Yannick C., Olie, Sabine E., Jellema, Korné, van de Beek, Diederik, Brouwer, Matthijs C.
Format: Journal Article
Language:English
Published: London Nature Publishing Group UK 27.10.2025
Nature Publishing Group
Nature Portfolio
Subjects:
692/617/375/1367
692/617/375/1638
Adult
Aged
Bacteria
Bacterial meningitis
Blood pressure
Central nervous system
Central nervous system infection
Central Nervous System Infections - diagnosis
Cerebrospinal fluid
Cohort analysis
Diagnostic tests
Emergency medical care
Encephalitis
Female
Glasgow Coma Scale
Head injuries
Heart rate
Humanities and Social Sciences
Humans
Inflammation
Intensive care
Intensive care unit
Intensive Care Units
Leukocytes
Male
Meningitis
Meningitis, Bacterial - diagnosis
Middle Aged
Mortality
multidisciplinary
Nervous system
Organ Dysfunction Scores
Pathogens
Patients
Prognosis
Prospective Studies
QSOFA
Science
Science (multidisciplinary)
Sepsis
SIRS
Streptococcus infections
Systemic inflammatory response syndrome
Systemic Inflammatory Response Syndrome - diagnosis
Netherlands
SIRS
Bacterial meningitis
QSOFA
Central nervous system infection
Intensive care unit
ISSN:2045-2322, 2045-2322
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Summary:Several scoring methods have been developed to identify critically ill patients with suspected sepsis who may benefit from intensive care treatment. We studied the prognostic value of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential related Organ Failure Assessment (qSOFA) score in patients with (suspected) central nervous system (CNS) infections. We included adult patients from two prospective cohort studies consisting of (1) patients who underwent a lumbar puncture for the suspicion of a CNS infection and (2) patients with confirmed bacterial meningitis. The primary outcome was Intensive Care Unit (ICU) admission. We calculated sensitivity, specificity, and area under the curve (AUC) for the SIRS score of > 2 and a qSOFA of > 2. From April 2007 to May 2022, 629 patients with a suspected CNS infection, and 326 patients with a bacterial meningitis were evaluated. 78 of 629 (12%) episodes with a suspected CNS infection were admitted to the ICU, and 197 of 326 (60%) with bacterial meningitis. The SIRS criteria showed a sensitivity of 81% (95%CI 70–89%) with a specificity of 48% (95%CI 44–52%) in patients with suspected CNS infection. Sensitivity of the qSOFA score was 67% (95%CI 55–77%) with a specificity of 82% (95%CI 78–85%) in the same cohort. The SIRS criteria showed a sensitivity of 94% (95%CI 89–97%) and specificity of 9% (95%CI 5–15%) in patients with bacterial meningitis. The qSOFA score had a sensitivity of 59% (95%CI 52–66%) and specificity of 52% (95%CI 43–61%) in bacterial meningitis patients. In patients with a suspected CNS infection the qSOFA score was more accurate than the SIRS criteria as a risk stratification tool for ICU admission. SIRS criteria and qSOFA score showed a poor performance for the prediction of ICU admission in bacterial meningitis patients. The limited value of SIRS and qSOFA criteria in these patient populations should be acknowledged and use in clinical practice should be approached with caution.
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ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-025-21163-7