Abdullah M. Algarni, Musa S. Alfaifi, Ali Al Bshabshe, Othman M. Omair, Mohammed A. Alsultan, Hasan M. Alzahrani, Hadi E. Alali, Abdullah A. Alsabaani, Ali M. Alqarni, Tim R. Harris, Salah A. Alghanem, Bandar S. Al Mufareh, Ayesha M. Almemari, Abdulrahman A. Sindi, Ibrahim U. Ozturan, Abdullah A. Alhadhira, Asaad S. Shujaa, Abdullah H. Alotaibi, Moosa M. Awladthani, Ahmed A. Alsaad, Abdullah A. Almarshed, AlHanouv M. AlQahtani, Bader Alyahya, Saad A. Assiri, Feras H. Abuzeyad, Sara N. Kazim, Abdulrahman A. Al-Fares, Faisal Y. Almazroua, Naif T. Marzook, Abdullah A. Basri, Abdallah M. Elsafti, Nader Mohammed, Ayisha Ameen, Abdulaziz S. Alalshaikh, Cansu A. Özturan, Yousef I. Alawad, Awad Alomari, Malek A. Alkhateeb, Moonis M. Farooq, Latifa Ali AlMutairi, Muneera M. Alasfour, Mohammad I. AlHaber, Umma Kulthum A. Umar, Nidal H. Bokhary, Abdulrhman Almutairi, Hisham F. Alyahya, Wejdan S. Alzahrani, Fawziah Alsalmi, Ahmed S. ALZomia, Abdulmajeed M. Omair, Faysal M. Alasmari, Sultan Y. Alfifi, Mohammed S. Al-Nujimi, Farid Foroutan
The accuracy of systemic inflammatory response syndrome (SIRS) criteria, quick sequential organ failure assessment (qSOFA), National Early Warning Score (NEWS and NEWS2), and Modified Early Warning Score (MEWS) in predicting sepsis outcomes among Middle Eastern populations remains uncertain. This international, multicenter, prospective cohort study included 3274 consecutive adult patients with suspected infections admitted through 20 emergency departments across Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, Turkey, and the United Arab Emirates. The primary outcome was 30-day in-hospital mortality. Of the participants (median age 62 years; 55.5% male), mortality was 8.8%. qSOFA showed the highest AUROC (0.75; 95% CI 0.72–0.78), outperforming SIRS (0.63; 95% CI 0.59–0.66) and MEWS (0.69; 95% CI 0.66–0.72; P < .001), and was comparable to NEWS2 (0.75; 95% CI 0.72–0.78; P = .99). Sensitivity was greater for NEWS ≥ 5 (73.9%), NEWS2 ≥ 5 (73.5%), and SIRS ≥ 2 (72.5%), compared with qSOFA ≥ 2 (42.2%) and MEWS ≥ 5 (40.1%). Conversely, specificity was highest for qSOFA ≥ 2 (89.0%) and MEWS ≥ 5 (83.0%), while SIRS ≥ 2 had the lowest specificity (48.6%). These findings suggest that although qSOFA and MEWS offer high specificity, their limited sensitivity risks missing many sepsis cases in emergency triage. NEWS2 provided the most balanced performance, although score selection should be guided by the intended clinical priority, including sensitivity for early identification, specificity for risk stratification, and local workflow.