Volume 100, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The quick sequential organ failure assessment (qSOFA) score has been proposed for risk stratification of emergency room patients with suspected infection. Its use of simple bedside observations makes qSOFA an attractive option for resource-limited regions. We prospectively assessed the predictive ability of qSOFA compared with systemic inflammatory response syndrome (SIRS), universal vital assessment (UVA), and modified early warning score (MEWS) in a resource-limited setting in Lambaréné, Gabon. In addition, we evaluated different adaptations of qSOFA and UVA in this cohort and an external validation cohort from Malawi. We included 279 cases, including 183 with an ad hoc (suspected) infectious disease diagnosis. Overall mortality was 5%. In patients with an infection, oxygen saturation, mental status, human immunodeficiency virus (HIV) status, and all four risk stratification score results differed significantly between survivors and non-survivors. The UVA score performed best in predicting mortality in patients with suspected infection, with an area under the receiving operator curve (AUROC) of 0.90 (95% confidence interval [CI]: 0.78–1.0, < 0.0001), outperforming qSOFA (AUROC 0.77; 95% CI: 0.63–0.91, = 0.0003), MEWS (AUROC 0.72; 95% CI: 0.58–0.87, = 0.01), and SIRS (AUROC 0.70; 95% CI: 0.52–0.88, = 0.03). An amalgamated qSOFA score applying the UVA thresholds for blood pressure and respiratory rate improved predictive ability in Gabon (AUROC 0.82; 95% CI: 0.68–0.96) but performed poorly in a different cohort from Malawi (AUROC 0.58; 95% CI: 0.51–0.64). In conclusion, UVA had the best predictive ability, but multicenter studies are needed to validate the qSOFA and UVA scores in various settings and assess their impact on patient outcome.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...


Data & Media loading...

Supplemental Tables

  • Received : 13 Jul 2018
  • Accepted : 10 Oct 2018
  • Published online : 26 Nov 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error