Publication:
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

1

Issued Date

2018-06-05

Resource Type

Article

ISSN

15383598
00987484

DOI

10.1001/jama.2018.6229

Other identifier(s)

2-s2.0-85048255823

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Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

JAMA - Journal of the American Medical Association. Vol.319, No.21 (2018), 2202-2211

Suggested Citation

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 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. JAMA - Journal of the American Medical Association. Vol.319, No.21 (2018), 2202-2211. doi:10.1001/jama.2018.6229 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/46593

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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

Author(s)

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

Other Contributor(s)

University of Sierra Leone
 University of Rwanda
 Ispat General Hospital
 UCL
 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

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.

Keyword(s)

Medicine

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https://repository.li.mahidol.ac.th/handle/123456789/46593

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Scopus 2018