Enhanced bedside mortality prediction combining point-of-care lactate and the quick Sequential Organ Failure Assessment (qSOFA) score in patients hospitalised with suspected infection in southeast Asia: a cohort study
Issued Date
2022-09-01
Resource Type
eISSN
2214109X
Scopus ID
2-s2.0-85135721933
Pubmed ID
35961351
Journal Title
The Lancet Global Health
Volume
10
Issue
9
Start Page
e1281
End Page
e1288
Rights Holder(s)
SCOPUS
Bibliographic Citation
The Lancet Global Health Vol.10 No.9 (2022) , e1281-e1288
Suggested Citation
Wright S.W., Hantrakun V., Rudd K.E., Lau C.Y., Lie K.C., Chau N.V.V., Teparrukkul P., West T.E., Limmathurotsakul D. Enhanced bedside mortality prediction combining point-of-care lactate and the quick Sequential Organ Failure Assessment (qSOFA) score in patients hospitalised with suspected infection in southeast Asia: a cohort study. The Lancet Global Health Vol.10 No.9 (2022) , e1281-e1288. e1288. doi:10.1016/S2214-109X(22)00277-7 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85587
Title
Enhanced bedside mortality prediction combining point-of-care lactate and the quick Sequential Organ Failure Assessment (qSOFA) score in patients hospitalised with suspected infection in southeast Asia: a cohort study
Author's Affiliation
Faculty of Tropical Medicine, Mahidol University
Oxford University Clinical Research Unit
Universitas Indonesia
University of Washington School of Medicine
University College London Hospitals NHS Foundation Trust
National Institute of Allergy and Infectious Diseases (NIAID)
University of Washington
University of Pittsburgh School of Medicine
Sunpasitthiprasong Hospital
Oxford University Clinical Research Unit
Universitas Indonesia
University of Washington School of Medicine
University College London Hospitals NHS Foundation Trust
National Institute of Allergy and Infectious Diseases (NIAID)
University of Washington
University of Pittsburgh School of Medicine
Sunpasitthiprasong Hospital
Other Contributor(s)
Abstract
Background: Simple, bedside prediction of infection-related mortality in low-resource settings is crucial for triage and resource-utilisation decisions. We aimed to evaluate mortality prediction by combining point-of-care venous lactate with the quick Sequential Organ Failure Assessment (qSOFA) score in adult patients admitted to hospital with suspected infection in southeast Asia. Methods: We performed a cohort study by prospectively enrolling patients aged 18 years or older who had been admitted to hospital within the previous 24 h for suspected infection (with at least three documented systemic manifestations of infection according to the 2012 Surviving Sepsis Campaign) at Sunpasitthiprasong Hospital in Ubon Ratchathani, Thailand (derivation cohort). Venous lactate concentration was determined by a point-of-care device and multiple scores were developed. We then evaluated candidate 28-day mortality prediction models combining qSOFA and the lactate scores. A final model was compared with the qSOFA score, a lactate score, and a modified Sequential Organ Failure Assessment (SOFA) score for mortality discrimination using the area under the receiver operating characteristic curve (AUROC). Mortality discrimination of the qSOFA-lactate score was then verified in an external, prospectively enrolled, multinational cohort in southeast Asia. Findings: Between March 1, 2013, and Jan 26, 2017, 5001 patients were enrolled in the derivation cohort; 4980 had point-of-care lactate data available and were eligible for analysis, and 816 died within 28 days of enrolment. The discrimination for 28-day mortality prediction of a qSOFA-lactate score combining the qSOFA score and a lactate score was superior to that of the qSOFA score alone (AUROC 0·78 [95% CI 0·76–0·80] vs 0·68 [0·67–0·70]; p<0·0001) and similar to a modified SOFA score (0·77 [0·75–0·78]; p=0·088). A lactate score alone had superior discrimination compared with the qSOFA score (AUROC 0·76 [95% CI 0·74–0·78]; p<0·0001). 815 patients were enrolled in the external validation cohort and 792 had point-of-care lactate data and were included in the analysis; the qSOFA-lactate score (AUROC 0·77 [95% CI 0·73–0·82]) showed significantly improved 28-day mortality discrimination compared with the qSOFA score alone (0·69 [0·63–0·74]; p<0·0001). Interpretation: In southeast Asia, rapid, bedside assessments based on point-of-care lactate concentration combined with the qSOFA score can identify patients at risk of sepsis-related mortality with greater accuracy than the qSOFA score alone, and with similar accuracy to a modified SOFA score. Funding: National Institutes of Health, Wellcome Trust.