Son Ngoc Do1,2,3, Chinh Quoc Luong2,3,4, My Ha Nguyen5, Dung Thi Pham6, Nga Thi Nguyen7, Dai Quang Huynh8,9, Quoc Trong Ai Hoang10, Co Xuan Dao1,2,3, Thang Dinh Vu11, Ha Nhat Bui12, Hung Tan Nguyen13, Hai Bui Hoang2,14, Thuy Thi Phuong Le15, Lien Thi Bao Nguyen16, Phuoc Thien Duong17, Tuan Dang Nguyen18, Vuong Hung Le19, Giang Thi Tra Pham20, Tam Van Bui7, Giang Thi Huong Bui1,2, Jason Phua21,22, Andrew Li22, Thao Thi Ngoc Pham8,9, Chi Van Nguyen2,4, Anh Dat Nguyen2,4. 1. Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam. 2. Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam. 3. Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam. 4. Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam. 5. Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam. 6. Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam. 7. Department of Intensive Care and Poison Control, Vietnam-Czechoslovakia Friendship Hospital, Hai Phong, Vietnam. 8. Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam. 9. Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. 10. Emergency Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam. 11. Intensive Care Unit, People's Hospital 115, Ho Chi Minh City, Vietnam. 12. Intensive Care Unit, Bai Chay General Hospital, Quang Ninh, Vietnam. 13. Intensive Care Unit, Da Nang Hospital, Da Nang City, Vietnam. 14. Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam. 15. Intensive Care Unit, Dong Da General Hospital, Hanoi, Vietnam. 16. Intensive Care Unit, Saint Paul General Hospital, Hanoi, Vietnam. 17. Intensive Care Unit, Can Tho Central General Hospital, Can Tho, Vietnam. 18. Intensive Care Unit, Vinmec Times City International Hospital, Hanoi, Vietnam. 19. Intensive Care Unit, Thai Nguyen National Hospital, Thai Nguyen, Vietnam. 20. Emergency Department, Thanh Nhan General Hospital, Hanoi, Vietnam. 21. FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore. 22. Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Health System, Singapore, Singapore.
Abstract
BACKGROUND: The simple scoring systems for predicting the outcome of sepsis in intensive care units (ICUs) are few, especially for limited-resource settings. Therefore, this study aimed to evaluate the accuracy of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in predicting the mortality of ICU patients with sepsis in Vietnam. METHODS: We did a multicenter cross-sectional study of patients with sepsis (≥18 years old) presenting to 15 adult ICUs throughout Vietnam on the specified days (i.e., 9th January, 3rd April, 3rd July, and 9th October) representing the different seasons of 2019. The primary and secondary outcomes were the hospital and ICU all-cause mortalities, respectively. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the discriminatory ability of the qSOFA score for deaths in the hospital and ICU. The cut-off value of the qSOFA scores was determined by the receiver operating characteristic curve analysis. Upon ICU admission, factors associated with the hospital and ICU mortalities were assessed in univariable and multivariable logistic models. RESULTS: Of 252 patients, 40.1% died in the hospital, and 33.3% died in the ICU. The qSOFA score had a poor discriminatory ability for both the hospital (AUROC: 0.610 [95% CI: 0.538 to 0.681]; cut-off value: ≥2.5; sensitivity: 34.7%; specificity: 84.1%; PAUROC = 0.003) and ICU (AUROC: 0.619 [95% CI: 0.544 to 0.694]; cutoff value: ≥2.5; sensitivity: 36.9%; specificity: 83.3%; PAUROC = 0.002) mortalities. However, multivariable logistic regression analyses show that the qSOFA score of 3 was independently associated with the increased risk of deaths in both the hospital (adjusted odds ratio, AOR: 3.358; 95% confidence interval, CI: 1.756 to 6.422) and the ICU (AOR: 3.060; 95% CI: 1.651 to 5.671). CONCLUSION: In our study, despite having a poor discriminatory value, the qSOFA score seems worthwhile in predicting mortality in ICU patients with sepsis in limited-resource settings. CLINICAL TRIAL REGISTRATION: Clinical trials registry-India: CTRI/2019/01/016898.
BACKGROUND: The simple scoring systems for predicting the outcome of sepsis in intensive care units (ICUs) are few, especially for limited-resource settings. Therefore, this study aimed to evaluate the accuracy of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in predicting the mortality of ICU patients with sepsis in Vietnam. METHODS: We did a multicenter cross-sectional study of patients with sepsis (≥18 years old) presenting to 15 adult ICUs throughout Vietnam on the specified days (i.e., 9th January, 3rd April, 3rd July, and 9th October) representing the different seasons of 2019. The primary and secondary outcomes were the hospital and ICU all-cause mortalities, respectively. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the discriminatory ability of the qSOFA score for deaths in the hospital and ICU. The cut-off value of the qSOFA scores was determined by the receiver operating characteristic curve analysis. Upon ICU admission, factors associated with the hospital and ICU mortalities were assessed in univariable and multivariable logistic models. RESULTS: Of 252 patients, 40.1% died in the hospital, and 33.3% died in the ICU. The qSOFA score had a poor discriminatory ability for both the hospital (AUROC: 0.610 [95% CI: 0.538 to 0.681]; cut-off value: ≥2.5; sensitivity: 34.7%; specificity: 84.1%; PAUROC = 0.003) and ICU (AUROC: 0.619 [95% CI: 0.544 to 0.694]; cutoff value: ≥2.5; sensitivity: 36.9%; specificity: 83.3%; PAUROC = 0.002) mortalities. However, multivariable logistic regression analyses show that the qSOFA score of 3 was independently associated with the increased risk of deaths in both the hospital (adjusted odds ratio, AOR: 3.358; 95% confidence interval, CI: 1.756 to 6.422) and the ICU (AOR: 3.060; 95% CI: 1.651 to 5.671). CONCLUSION: In our study, despite having a poor discriminatory value, the qSOFA score seems worthwhile in predicting mortality in ICU patients with sepsis in limited-resource settings. CLINICAL TRIAL REGISTRATION: Clinical trials registry-India: CTRI/2019/01/016898.
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