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Title: Association of the quick sequential (sepsis-related) organ failure assessment (qSOFA) score with excess hospital mortality in adults with suspected infection in low- and middle-income countries
Authors: Kristina E. Rudd
Christopher W. Seymour
Adam R. Aluisio
Marc E. Augustin
Danstan S. Bagenda
Abi Beane
Jean Claude Byiringiro
Chung Chou H. Chang
L. Nathalie Colas
Nicholas P.J. Day
A. Pubudu De Silva
Arjen M. Dondorp
Martin W. Dünser
M. Abul Faiz
Donald S. Grant
Rashan Haniffa
Nguyen Van Hao
Jason N. Kennedy
Adam C. Levine
Direk Limmathurotsakul
Sanjib Mohanty
François Nosten
Alfred Papali
Andrew J. Patterson
John S. Schieffelin
Jeffrey G. Shaffer
Duong Bich Thuy
C. Louise Thwaites
Olivier Urayeneza
Nicholas J. White
T. Eoin West
Derek C. Angus
University of Sierra Leone
University of Rwanda
Ispat General Hospital
Johannes Kepler Universitat Linz
Tulane University
University of Nebraska Medical Center
University of Pittsburgh
University of Washington, Seattle
Tulane University School of Medicine
University of Maryland School of Medicine
Mahidol University
The Warren Alpert Medical School of Brown University
Nuffield Department of Clinical Medicine
University of Pittsburgh School of Medicine
Amsterdam UMC - University of Amsterdam
Oxford University Clinical Research Unit
Asian Institute of Public Health
Division of Pulmonary and Critical Care Medicine
University of Gitwe
Saint Luke Foundation
National Intensive Care Surveillance
Dev Care Foundation
University of Medicine and Pharmacy
Intensive Care National Audit and Research Centre
Kenema Government Hospital
Keywords: Medicine
Issue Date: 5-Jun-2018
Citation: JAMA - Journal of the American Medical Association. Vol.319, No.21 (2018), 2202-2211
Abstract: © 2018 American Medical Association. All rights reserved. IMPORTANCE The quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score has not been well-evaluated in low- and middle-income countries (LMICs). OBJECTIVE To assess the association of qSOFA with excess hospital death among patients with suspected infection in LMICs and to compare qSOFA with the systemic inflammatory response syndrome (SIRS) criteria. DESIGN, SETTINGS, AND PARTICIPANTS Retrospective secondary analysis of 8 cohort studies and 1 randomized clinical trial from 2003 to 2017. This study included 6569 hospitalized adults with suspected infection in emergency departments, inpatient wards, and intensive care units of 17 hospitals in 10 LMICs across sub-Saharan Africa, Asia, and the Americas. EXPOSURES Low (0), moderate (1), or high (2) qSOFA score (range, 0 [best] to 3 [worst]) or SIRS criteria (range, 0 [best] to 4 [worst]) within 24 hours of presentation to study hospital. MAIN OUTCOMES AND MEASURES Predictive validity (measured as incremental hospital mortality beyond that predicted by baseline risk factors, as a marker of sepsis or analogous severe infectious course) of the qSOFA score (primary) and SIRS criteria (secondary). RESULTS The cohorts were diverse in enrollment criteria, demographics (median ages, 29-54 years; males range, 36%-76%), HIV prevalence (range, 2%-43%), cause of infection, and hospital mortality (range, 1%-39%). Among 6218 patients with nonmissing outcome status in the combined cohort, 643 (10%) died. Compared with a low or moderate score, a high qSOFA score was associated with increased risk of death overall (19% vs 6%; difference, 13% [95% CI, 11%-14%]; odds ratio, 3.6 [95% CI, 3.0-4.2]) and across cohorts (P < .05 for 8 of 9 cohorts). Compared with a low qSOFA score, a moderate qSOFA score was also associated with increased risk of death overall (8% vs 3%; difference, 5% [95% CI, 4%-6%]; odds ratio, 2.8 [95% CI, 2.0-3.9]), but not in every cohort (P < .05 in 2 of 7 cohorts). High, vs low or moderate, SIRS criteria were associated with a smaller increase in risk of death overall (13% vs 8%; difference, 5% [95% CI, 3%-6%]; odds ratio, 1.7 [95% CI, 1.4-2.0]) and across cohorts (P < .05 for 4 of 9 cohorts). qSOFA discrimination (area under the receiver operating characteristic curve [AUROC], 0.70 [95% CI, 0.68-0.72]) was superior to that of both the baseline model (AUROC, 0.56 [95% CI, 0.53-0.58; P < .001) and SIRS (AUROC, 0.59 [95% CI, 0.57-0.62]; P < .001). CONCLUSIONS AND RELEVANCE When assessed among hospitalized adults with suspected infection in 9 LMIC cohorts, the qSOFA score identified infected patients at risk of death beyond that explained by baseline factors. However, the predictive validity varied among cohorts and settings, and further research is needed to better understand potential generalizability.
ISSN: 15383598
Appears in Collections:Scopus 2018

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