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Title: Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: A multinational multicenter prospective observational study
Authors: Khie Chen Lie
Chuen Yen Lau
Nguyen Van Vinh Chau
T. Eoin West
Direk Limmathurotsakul
Pratiwi Sudarmono
Abu Tholib Aman
Mansyur Arif
Armaji Kamaludi Syarif
Herman Kosasih
Muhammad Karyana
Tawee Chotpitayasunondh
Warunee Punpanich Vandepitte
Adiratha Boonyasiri
Keswadee Lapphra
Kulkanya Chokephaibulkit
Pinyo Rattanaumpawan
Visanu Thamlikitkul
Achara Laongnualpanich
Prapit Teparrakkul
Pramot Srisamang
Phan Huu Phuc
Le Thanh Hai
Nguyen Van Kinh
Bui Duc Phu
Nguyen Thanh Hung
Tang Chi Thuong
Ha Manh Tuan
Lam Minh Yen
Nguyen Van Vinh Chau
Janjira Thaipadungpanit
Stuart Blacksell
Nicholas Day
Claire Ling
Guy Thwaites
Heiman Wertheim
Le Van Tan
Motiur Rahman
H. Rogier van Doorn
Sappasitthiprasong Hospital
Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia
University of Indonesia, RSUPN Dr. Cipto Mangunkusumo
National Institute of Allergy and Infectious Diseases
University of Washington, Seattle
Mahidol University
Faculty of Medicine, Siriraj Hospital, Mahidol University
Queen Sirikit National Institute of Child Health
Nuffield Department of Clinical Medicine
Oxford University Clinical Research Unit
Hue Central Hospital
National Hospital of Peadiatrics
Wahidin Soedirohusodo Hospital
Shoklo Malaria Research Unit
Children's Hospital 2
Children's Hospital 1
Sardjito Hospital
National Hospital of Tropical Diseases
Chiangrai Prachanukroh Hospital
Oxford University Clinical Research Unit
Keywords: Medicine
Issue Date: 14-Feb-2018
Citation: Journal of Intensive Care. Vol.6, No.1 (2018)
Abstract: © 2018 The Author(s). Background: Sepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia. Methods: We prospectively recruited hospitalized adults within 24 h of admission with community-acquired infection at nine public hospitals in Indonesia (n=3), Thailand (n=3), and Vietnam (n=3). In patients with organ dysfunction (total SOFA score ≥2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥3 for an individual organ system. Results: From December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24 h of admission was low: broad-spectrum antibiotics in 76% (344/454), ≥1500 mL fluid in 50% of patients with hypotension or lactate ≥4 mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, p<0.001). The number of organ failures showed a significant correlation with 28-day mortality, which ranged from 7% in patients without any organ failure to 47% in those with failure of at least four organs (p<0.001). The area under the receiver operating characteristic curve of the total SOFA score for discrimination of mortality was 0.68 (95% CI 0.62-0.74). Conclusions: Community-acquired sepsis in Southeast Asia due to a variety of pathogens is usually managed outside the ICU and with poor compliance to sepsis bundles. In this population, calculation of SOFA scores is feasible and SOFA scores are associated with mortality.
ISSN: 20520492
Appears in Collections:Scopus 2018

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