SIRS Criteria + qSOFA Sepsis Screening
Bedside sepsis screening combining the classical SIRS criteria with the quick SOFA (qSOFA) score. Aligned with Sepsis-3 (JAMA 2016), Surviving Sepsis Campaign 2021, and ISCCM India sepsis guidelines.
SIRS Criteria (Bone 1992)
qSOFA (Sepsis-3, 2016)
SIRS
0/4
Negative
qSOFA
0/3
Low risk
Interpretation
Low immediate risk by both scores.
Action (SSC 2021 hour-1 bundle)
Continue routine monitoring. Re-score if clinical change. Remember: a single normal qSOFA / SIRS does NOT rule out early sepsis — clinical gestalt always trumps.
The sepsis bundle, pre-filled the moment qSOFA hits 2
Every hour of delayed antibiotics in septic shock increases mortality by 7.6%. EasyClinic's sepsis alert auto-orders lactate, cultures, and the ICMR-recommended empirical antibiotic with the right dose by eGFR — so your nurse only has to confirm.
Also Known As
SIRS vs qSOFA — What is the difference?
SIRS (Systemic Inflammatory Response Syndrome — Bone 1992) is the classical 4-criterion bedside screen. It is highly sensitive but very non-specific — patients with pancreatitis, trauma, or burns also meet SIRS without infection.
qSOFA (quick SOFA — Singer 2016, Sepsis-3) was designed as a bedside tool to identify infected patients at high risk of poor outcome. It is more specific but less sensitive than SIRS.
The current consensus: use both. SIRS for screening, qSOFA + lactate for risk stratification, and SOFA score for formal sepsis diagnosis.
Sepsis-3 Definitions (JAMA 2016)
- Sepsis = Life-threatening organ dysfunction caused by a dysregulated host response to infection. Clinically: suspected infection + acute SOFA ≥ 2.
- Septic shock = Sepsis + persisting hypotension requiring vasopressors to maintain MAP ≥ 65 mmHg AND serum lactate > 2 mmol/L despite adequate fluid resuscitation. In-hospital mortality > 40%.
- qSOFA ≥ 2: 10× higher mortality vs < 2 in infected patients.
Surviving Sepsis Campaign Hour-1 Bundle (2021)
Initiate all five within one hour of recognition:
- Measure lactate. Re-measure if > 2 mmol/L.
- Obtain blood cultures before antibiotics (do not delay antibiotics > 45 min).
- Administer broad-spectrum IV antibiotics.
- Begin rapid crystalloid 30 mL/kg for hypotension or lactate ≥ 4 mmol/L.
- Start vasopressors during or after fluid resuscitation to maintain MAP ≥ 65 mmHg.
ICMR / ISCCM Empirical Antibiotics for Sepsis in India
- Community-acquired sepsis, unknown source: Piperacillin-tazobactam 4.5g IV Q8H (~₹1,350/day) or Ceftriaxone 2g IV OD (~₹120/day) + Metronidazole.
- Healthcare-associated / late-onset: Meropenem 1g IV Q8H (~₹1,200/day) ± Vancomycin 15mg/kg Q12H (~₹600/day) for MRSA.
- Septic shock / neutropenia / known ESBL: Meropenem + Vancomycin ± Amikacin 15mg/kg OD (~₹150/day). Consider Colistin (~₹2,500/day) if CR-Klebsiella prevalence high.
- Source control: Drain abscess, remove infected lines, debride within 6–12 hours.
- De-escalate: Narrow spectrum based on cultures within 48–72 hours. Stop empiric anti-MRSA cover if cultures negative.
When SIRS / qSOFA Mislead
- Beta-blocked patients: blunted tachycardia → may miss SIRS.
- Elderly: hypothermia and altered mentation are subtle; lactate is more reliable.
- Pregnancy: physiological tachycardia, leukocytosis confound SIRS. Use omqSOFA or MEOWS.
- Cirrhosis: chronic vasodilation → baseline low SBP. Use trend, not absolute values.
- Immunosuppressed: blunted inflammatory response — high suspicion needed even without SIRS/qSOFA.
Frequently Asked Questions
▸Has SIRS been replaced by qSOFA?
Not entirely. Sepsis-3 (2016) deprecated SIRS for the formal sepsis definition, replacing it with the SOFA score. However, SIRS is still useful as an early screen because of its high sensitivity. Most Indian ED protocols use SIRS for screening and qSOFA to escalate.
▸How sensitive is qSOFA for early sepsis?
Sensitivity around 60-70% within the ED setting and even lower in the prehospital/early phase. It is highly specific (~80%) for adverse outcomes but misses 30-40% of patients who will deteriorate. Combine with clinical gestalt, lactate, and NEWS2.
▸What is the difference between qSOFA and SOFA?
qSOFA uses only 3 bedside variables (RR, mental status, SBP). Full SOFA uses 6 organ-system scores (respiratory, coagulation, liver, cardiovascular, CNS, renal) and requires labs. Sepsis-3 defines sepsis as infection + SOFA ≥ 2. qSOFA is a prompt to calculate full SOFA.
▸Should I start antibiotics before cultures?
Surviving Sepsis 2021 says blood cultures should be obtained before antibiotics, BUT antibiotics should NOT be delayed more than 45 minutes for cultures. In septic shock, start antibiotics within 1 hour even if cultures cannot be drawn.
▸My hospital cannot do lactate at the bedside — what do I do?
Send a venous lactate to the lab — venous lactate correlates closely with arterial. If no lactate available, use clinical surrogates: capillary refill > 3s, mottling (LUCAS score), oliguria, altered mentation. Do not delay treatment.
▸How do I score qSOFA in a ventilated/sedated patient?
Mental status is unreliable. Use RR before sedation/intubation if known, and SBP. Most ICUs switch to full SOFA scoring once a patient is on mechanical ventilation, since SpO₂/FiO₂ and vasopressor dose become trackable.
References
- Singer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801-10
- Evans L et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021;49(11):e1063-e1143
- Levy MM et al. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med 2018;44(6):925-928
- ISCCM Indian Sepsis Guidelines 2022 — Indian Society of Critical Care Medicine
- ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes, 2022 — Sepsis chapter
- Bone RC et al. Definitions for sepsis and organ failure. Chest 1992;101(6):1644-55 (original SIRS)
Catch sepsis 4 hours earlier — automatically
EasyClinic continuously screens every inpatient's vitals against SIRS, qSOFA, and NEWS2. When two criteria trigger, the nurse and treating doctor get an instant alert with the hour-1 sepsis bundle pre-filled — lactate, cultures, antibiotics, fluids, vasopressors.
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