Adam R Aluisio1, Stephanie Garbern2, Tess Wiskel2, Zeta A Mutabazi3, Olivier Umuhire4, Chin Chin Ch'ng5, Kristina E Rudd6, Jeanne D'Arc Nyinawankusi7, Jean Claude Byiringiro3, Adam C Levine2. 1. Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA. Electronic address: adam.aluisio@gmail.com. 2. Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA. 3. University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda. 4. Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda. 5. Brown University School of Public Health, Providence, USA. 6. Department of Medicine, University of Washington, Seattle, USA. 7. Service d'Aide Médicale Urgente, Kigali, Rwanda.
Abstract
OBJECTIVE: To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting. METHODS: This retrospective cohort study was carried out at a tertiary-care hospital, in Kigali, Rwanda and included patients ≥15years, presenting for ED care during 2013 with an infectious disease (ID). ED and overall hospital mortality were evaluated using multivariable regression, with qSOFA scores as the primary predictor (reference: qSOFA=0), to yield adjusted relative risks (aRR) with 95% confidence intervals (CI). Analyses were performed for the overall population and stratified by HIV status. RESULTS: Among 15,748 cases, 760 met inclusion (HIV infected 197). The most common diagnoses were malaria and intra-abdominal infections. Prevalence of ED and hospital mortality were 12.5% and 25.4% respectively. In the overall population, ED mortality aRR was 4.8 (95% CI 1.9-12.0) for qSOFA scores equal to 1 and 7.8 (95% CI 3.1-19.7) for qSOFA scores ≥2. The aRR for hospital mortality in the overall cohort was 2.6 (95% 1.6-4.1) for qSOFA scores equal to 1 and 3.8 (95% 2.4-6.0) for qSOFA scores ≥2. For HIV infected cases, although proportional mortality increased with greater qSOFA score, statistically significant risk differences were not identified. CONCLUSION: The qSOFA score provided risk stratification for both ED and hospital mortality outcomes in the setting studied, indicating utility in sepsis care in SSA, however, further prospective study in high-burden HIV populations is needed.
OBJECTIVE: To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting. METHODS: This retrospective cohort study was carried out at a tertiary-care hospital, in Kigali, Rwanda and included patients ≥15years, presenting for ED care during 2013 with an infectious disease (ID). ED and overall hospital mortality were evaluated using multivariable regression, with qSOFA scores as the primary predictor (reference: qSOFA=0), to yield adjusted relative risks (aRR) with 95% confidence intervals (CI). Analyses were performed for the overall population and stratified by HIV status. RESULTS: Among 15,748 cases, 760 met inclusion (HIV infected 197). The most common diagnoses were malaria and intra-abdominal infections. Prevalence of ED and hospital mortality were 12.5% and 25.4% respectively. In the overall population, ED mortality aRR was 4.8 (95% CI 1.9-12.0) for qSOFA scores equal to 1 and 7.8 (95% CI 3.1-19.7) for qSOFA scores ≥2. The aRR for hospital mortality in the overall cohort was 2.6 (95% 1.6-4.1) for qSOFA scores equal to 1 and 3.8 (95% 2.4-6.0) for qSOFA scores ≥2. For HIV infected cases, although proportional mortality increased with greater qSOFA score, statistically significant risk differences were not identified. CONCLUSION: The qSOFA score provided risk stratification for both ED and hospital mortality outcomes in the setting studied, indicating utility in sepsis care in SSA, however, further prospective study in high-burden HIV populations is needed.
Authors: Mervyn Singer; Clifford S Deutschman; Christopher Warren Seymour; Manu Shankar-Hari; Djillali Annane; Michael Bauer; Rinaldo Bellomo; Gordon R Bernard; Jean-Daniel Chiche; Craig M Coopersmith; Richard S Hotchkiss; Mitchell M Levy; John C Marshall; Greg S Martin; Steven M Opal; Gordon D Rubenfeld; Tom van der Poll; Jean-Louis Vincent; Derek C Angus Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: Sung Yeon Hwang; Ik Joon Jo; Se Uk Lee; Tae Rim Lee; Hee Yoon; Won Chul Cha; Min Seob Sim; Tae Gun Shin Journal: Ann Emerg Med Date: 2017-06-29 Impact factor: 5.721
Authors: Matthew M Churpek; Ashley Snyder; Xuan Han; Sarah Sokol; Natasha Pettit; Michael D Howell; Dana P Edelson Journal: Am J Respir Crit Care Med Date: 2017-04-01 Impact factor: 21.405
Authors: Brad S Karon; Nicole V Tolan; Amy M Wockenfus; Darci R Block; Nikola A Baumann; Sandra C Bryant; Casey M Clements Journal: Clin Biochem Date: 2017-05-25 Impact factor: 3.281
Authors: Adam R Aluisio; Ashika Jain; Bonny J Baron; Saman Sarraf; Richard Sinert; Eric Legome; Shahriar Zehtabchi Journal: Am J Emerg Med Date: 2015-10-22 Impact factor: 2.469
Authors: Shevin T Jacob; Christopher C Moore; Patrick Banura; Relana Pinkerton; David Meya; Pius Opendi; Steven J Reynolds; Nathan Kenya-Mugisha; Harriet Mayanja-Kizza; W Michael Scheld Journal: PLoS One Date: 2009-11-11 Impact factor: 3.240
Authors: Gabin Mbanjumucyo; Naomi George; Alexis Kearney; Naz Karim; Adam R Aluisio; Zeta Mutabazi; Olivier Umuhire; Samuel Enumah; John W Scott; Eric Uwitonze; Jeanne D'Arc Nyinawankusi; Jean Claude Byiringiro; Ignace Kabagema; Georges Ntakiyiruta; Sudha Jayaraman; Robert Riviello; Adam C Levine Journal: Afr J Emerg Med Date: 2016-10-28
Authors: 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 Journal: JAMA Date: 2018-06-05 Impact factor: 56.272
Authors: Manus Schmedding; Bayode R Adegbite; Susan Gould; Justin O Beyeme; Akim A Adegnika; Martin P Grobusch; Michaëla A M Huson Journal: Am J Trop Med Hyg Date: 2019-01 Impact factor: 2.345
Authors: Raphael Kazidule Kayambankadzanja; Carl Otto Schell; Felix Namboya; Tamara Phiri; Grace Banda-Katha; Samson Kwazizira Mndolo; Andy Bauleni; Markus Castegren; Tim Baker Journal: Am J Trop Med Hyg Date: 2020-04 Impact factor: 2.345
Authors: Adam R Aluisio; Meagan A Barry; Kyle D Martin; Gabin Mbanjumucyo; Zeta A Mutabazi; Naz Karim; Rachel T Moresky; Jeanne D'Arc Nyinawankusi; Jean Claude Byiringiro; Adam C Levine Journal: Afr J Emerg Med Date: 2018-10-13
Authors: Adam R Aluisio; Shahan Waheed; Peter Cameron; Jermey Hess; Shevin T Jacob; Niranjan Kissoon; Adam C Levine; Asad Mian; Shammi Ramlakhan; Hendry R Sawe; Junaid Razzak Journal: BMJ Glob Health Date: 2019-07-29
Authors: Peter Mattson; Ezechiel Nteziryayo; Adam R Aluisio; Michael Henry; Noah Rosenberg; Zeta A Mutabazi; Jeanne D'Arc Nyinawankusi; Jean Claude Byiringiro; Adam C Levine; Naz Karim Journal: West J Emerg Med Date: 2019-10-14
Authors: Amanda Klinger; Ariel Mueller; Tori Sutherland; Christophe Mpirimbanyi; Elie Nziyomaze; Jean-Paul Niyomugabo; Zack Niyonsenga; Jennifer Rickard; Daniel S Talmor; Elisabeth Riviello Journal: BMJ Open Date: 2021-02-10 Impact factor: 2.692
Authors: Jonas Früh; Andre Fuchs; Tafese Beyene Tufa; Loraine Früh; Zewdu Hurissa; Hans Martin Orth; Johannes Georg Bode; Kirsten Alexandra Eberhardt; Dieter Häussinger; Torsten Feldt Journal: PLoS One Date: 2021-02-04 Impact factor: 3.240