Singer M et al. 2016. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315: 801–810.
Seymour CW et al. 2016. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic Shock (sepsis-3). JAMA 315: 762–774.
Song JU, Sin CK, Park HK, Shim SR, Lee J, 2018. Performance of the quick sequential (sepsis-related) organ failure assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis. Crit Care 22: 28.
Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJE, Perry JJ, 2018. Prognostic accuracy of the quick sequential organ failure assessment for mortality in patients with suspected infection: a systematic review and meta-analysis. Ann Intern Med 168: 266–275.
Serafim R, Gomes JA, Salluh J, Povoa P, 2018. A comparison of the quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of sepsis and prediction of mortality: a systematic review and meta-analysis. Chest 153: 646–655.
Maitra S, Som A, Bhattacharjee S, 2018. Accuracy of quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: a meta-analysis of observational studies. Clin Microbiol Infect 24: 1123–1129.
Huson MA, Kalkman R, Grobusch MP, van der Poll T, 2017. Predictive value of the qSOFA score in patients with suspected infection in a resource limited setting in Gabon. Travel Med Infect Dis 15: 76–77.
Huson MAM, Katete C, Chunda L, Ngoma J, Wallrauch C, Heller T, van der Poll T, Grobusch MP, 2017. Application of the qSOFA score to predict mortality in patients with suspected infection in a resource-limited setting in Malawi. Infection 45: 893–896.
Aluisio AR, Garbern S, Wiskel T, Mutabazi ZA, Umuhire O, Ch’ng CC, Rudd KE, D'Arc Nyinawankusi J, Byiringiro JC, Levine AC, 2018. Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country. Am J Emerg Med 36: 2010–2019.
Boillat-Blanco N, Mbarack Z, Samaka J, Mlaganile T, Mamin A, Genton B, Kaiser L, Calandra T, D’Acremont V, 2018. Prognostic value of quickSOFA as a predictor of 28-day mortality among febrile adult patients presenting to emergency departments in Dar es Salaam, Tanzania. PLoS One 13: e0197982.
Rudd KE et al. 2018. 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 319: 2202–2211.
Bone RC, Sprung CL, Sibbald WJ, 1992. Definitions for sepsis and organ failure. Crit Care Med 20: 724–726.
Subbe CP, Kruger M, Rutherford P, Gemmel L, 2001. Validation of a modified early warning score in medical admissions. QJM 94: 521–526.
Moore CC et al. 2017. Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa. BMJ Glob Health 2: e000344.
Hajian-Tilaki K, 2014. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform 48: 193–204.
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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, P < 0.0001), outperforming qSOFA (AUROC 0.77; 95% CI: 0.63–0.91, P = 0.0003), MEWS (AUROC 0.72; 95% CI: 0.58–0.87, P = 0.01), and SIRS (AUROC 0.70; 95% CI: 0.52–0.88, P = 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.
Authors’ addresses: Manus Schmedding, Division of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon, E-mail: mhfe.schmedding@gmail.com. Bayode R. Adegbite, Susan Gould, and Akim A. Adegnika, Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon, E-mails: aromakobs@gmail.com, goulds606@doctors.org.uk, and aadegnika@cermel.org. Justin O. Beyeme, Albert Schweitzer Hospital, Lambaréné, Gabon, E-mail: justinomva@yahoo.fr. Martin P. Grobusch, Division of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon, Albert Schweitzer Hospital, Lambaréné, Gabon, and German Center for Infection Research, Institute of Tropical Medicine, University of Tübingen and Partner site Tübingen, Tübingen, Germany, E-mail: m.p.grobusch@amc.nl. Michaëla A. M. Huson, Division of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, E-mail: m.a.huson@amc.uva.nl.
These authors contributed equally to this work.
Singer M et al. 2016. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315: 801–810.
Seymour CW et al. 2016. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic Shock (sepsis-3). JAMA 315: 762–774.
Song JU, Sin CK, Park HK, Shim SR, Lee J, 2018. Performance of the quick sequential (sepsis-related) organ failure assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis. Crit Care 22: 28.
Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJE, Perry JJ, 2018. Prognostic accuracy of the quick sequential organ failure assessment for mortality in patients with suspected infection: a systematic review and meta-analysis. Ann Intern Med 168: 266–275.
Serafim R, Gomes JA, Salluh J, Povoa P, 2018. A comparison of the quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of sepsis and prediction of mortality: a systematic review and meta-analysis. Chest 153: 646–655.
Maitra S, Som A, Bhattacharjee S, 2018. Accuracy of quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: a meta-analysis of observational studies. Clin Microbiol Infect 24: 1123–1129.
Huson MA, Kalkman R, Grobusch MP, van der Poll T, 2017. Predictive value of the qSOFA score in patients with suspected infection in a resource limited setting in Gabon. Travel Med Infect Dis 15: 76–77.
Huson MAM, Katete C, Chunda L, Ngoma J, Wallrauch C, Heller T, van der Poll T, Grobusch MP, 2017. Application of the qSOFA score to predict mortality in patients with suspected infection in a resource-limited setting in Malawi. Infection 45: 893–896.
Aluisio AR, Garbern S, Wiskel T, Mutabazi ZA, Umuhire O, Ch’ng CC, Rudd KE, D'Arc Nyinawankusi J, Byiringiro JC, Levine AC, 2018. Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country. Am J Emerg Med 36: 2010–2019.
Boillat-Blanco N, Mbarack Z, Samaka J, Mlaganile T, Mamin A, Genton B, Kaiser L, Calandra T, D’Acremont V, 2018. Prognostic value of quickSOFA as a predictor of 28-day mortality among febrile adult patients presenting to emergency departments in Dar es Salaam, Tanzania. PLoS One 13: e0197982.
Rudd KE et al. 2018. 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 319: 2202–2211.
Bone RC, Sprung CL, Sibbald WJ, 1992. Definitions for sepsis and organ failure. Crit Care Med 20: 724–726.
Subbe CP, Kruger M, Rutherford P, Gemmel L, 2001. Validation of a modified early warning score in medical admissions. QJM 94: 521–526.
Moore CC et al. 2017. Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa. BMJ Glob Health 2: e000344.
Hajian-Tilaki K, 2014. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform 48: 193–204.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 593 | 463 | 17 |
Full Text Views | 1705 | 19 | 0 |
PDF Downloads | 349 | 18 | 0 |