Sepsis-3 and its Assesment Tools (Sofa and Qsofa): Historical Evolution, Clinical Utility and Criticisms

Pandya Bhagaskara; Nurul Wiqoyah

Authors

Pandya Bhagaskara Department of Medical Microbiology and Parasitology, Faculty of Medicine Universitas Airlangga Indonesia, Indonesia
Nurul Wiqoyah Department of Medical Microbiology and Parasitology, Faculty of Medicine Universitas Airlangga Indonesia, Indonesia

Keywords:

Sepsis-3, SOFA, qSOFA, SIRS, Organ Dysfunction, Diagnostic Criteria

Abstract

Sepsis remains a major global health problem with high morbidity and mortality. Over the past three decades, evolving consensus definitions have sought to improve diagnostic accuracy and patient outcomes. The latest definition, Sepsis-3, defines sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, with the Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) as key tools. This review outlines the historical development of sepsis definitions, examines the role of SOFA and qSOFA, and summarizes their strengths and criticisms. Sepsis-3 marked a shift from inflammation-based to organ dysfunction–centered criteria. Evidence shows that SOFA is highly accurate for prognosis in intensive care, while qSOFA is useful for bedside risk stratification outside the ICU. Both outperform systemic inflammatory response syndrome (SIRS) in specificity, though SOFA requires laboratory parameters and qSOFA shows reduced sensitivity. Some authors argue SIRS should not be entirely discarded due to its early recognition value. In conclusion, Sepsis-3 advanced the standardization of sepsis definitions, yet challenges remain, and this article was written to provide a concise overview of its evolution, utility, and ongoing debates.

Keywords: Sepsis-3, SOFA, qSOFA, SIRS, sepsis definitions

References

Balk, R., Cerra, F. F. B., & Philip, M. D. R. (1992). accplsccm consensus conference. Chest, 101, 1644–1655.

Gary, T., Mingle, D., & Yenamandra, A. (2016). The evolving definition of sepsis. ArXiv Preprint ArXiv:1609.07214.

Gauer, R., Forbes, D., & Boyer, N. (2020). Sepsis: diagnosis and management. American Family Physician, 101(7), 409–418.

Geroulanos, S., & Douka, E. T. (2006). Historical perspective of the word “sepsis.” Intensive Care Medicine, 32(12), 2077.

Gyawali, B., Ramakrishna, K., & Dhamoon, A. S. (2019). Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Medicine, 7, 2050312119835043.

Khwannimit, B., Bhurayanontachai, R., & Vattanavanit, V. (2018). Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. Journal of Critical Care, 44, 156–160.

Levy, M. M., Fink, M. P., Marshall, J. C., Abraham, E., Angus, D., Cook, D., Cohen, J., Opal, S. M., Vincent, J.-L., & Ramsay, G. (2003). 2001 sccm/esicm/accp/ats/sis international sepsis definitions conference. Critical Care Medicine, 31(4), 1250–1256

Raith, E. P., Udy, A. A., Bailey, M., McGloughlin, S., MacIsaac, C., Bellomo, R., & Pilcher, D. V. (2017). Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. Jama, 317(3), 290–300.

Rudd, K. E., Johnson, S. C., Agesa, K. M., Shackelford, K. A., Tsoi, D., Kievlan, D. R., Colombara, D. V, Ikuta, K. S., Kissoon, N., & Finfer, S. (2020). Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet, 395(10219), 200–211.

Seymour, C. W., Liu, V. X., Iwashyna, T.J., Brunkhorst, F. M., Rea, T. D., Scherag, A., Rubenfeld, G., Kahn, J. M., Shankar-Hari, M., & Singer, M. (2016). Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama, 315(8), 762–774.

Shankar-Hari, M., Phillips, G. S., Levy, M. L., Seymour, C. W., Liu, V. X.,