Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings

Andrew Li, Lowell Ling, Hanyu Qin, Yaseen M. Arabi, Sheila Nainan Myatra, Moritoki Egi, Je Hyeong Kim, Mohd Basri Mat Nor, Do Ngoc Son, Wen‐Feng Fang

90 more authors

Bambang Wahyuprajitno, Madiha Hashmi, Mohammad Omar Faruq, Boonsong Patjanasoontorn, Maher Jaffer Al Bahrani, Babu Raja Shrestha, Ujma Shrestha, Khalid Mahmood Khan Nafees, Kyi Kyi Sann, Jose Emmanuel Palo, Naranpurev Mendsaikhan, Aidos K. Konkayev, Khamsay Detleuxay, Yiong Huak Chan, Bin Du, Jigeeshu Vasishtha Divatia, Younsuck Koh, Jason Phua, the MOSAICS II Study Group, Utkalika Mallick, Motiul Islam, Tarequl Hamid, A. K. M. Shirazul Islam, Mohammad Rabiul Halim, Md. Arifur Rahman Khan, Mohammad Asaduzzaman, Md Rezaul Karim, Nahim Sarwar, Shamsul Hoque Milon, Rashed Mahmud, A. K. M. Sirajul Islam Hirok, Ashraful Haque, Amina Sultana, Mir Atiqur Rahman Shajal, Farha Andalib, Rashedul Hasan, Khalid Mahmood Khan Nafees, Shah Sudhirchandra Dhansukhlal, Ning Li, Xiaowei Liu, Haiwei Yang, Ming Hou, Ying Li, Jian Zhang, Lifeng Huang, Wenxiong Li, Meili Duan, Taotao Liu, Wei Wu He, Fangyu Ning, Xiaozhi Wang, Xiaoyan Zhou, Sun Yu, Xiang Xiang, Liang Pan, Feihu Zhou, Yaoli Wang, Jian Zhou, Tao Wang, Xuefei Yang, Yu Ma, Xuan Song, Haiying Wu, Chuanyun Qian, Lixin Zhou, Zuohang Xu, Kun Zhang, Zhenjie Hu, Xingsheng Lin, Songjing Shi, Xiaoguang Zhang, Rongguo Yu, Liqin Zhang, Yuan Yuan, Huiru Zhou, Xiandong Wang, Zhonghua Wang, Tiehe Qin, Xianqing Shi, Rui Li, Zhenyang He, Xiangrong Zuo, Quan Cao, Tao He, Yuanda Sui, Tiejun Wu, Ying Xu, Qin Gu, Weizheng Shuai, Hanyu Qin

Critical Care, 2024

Full text Open access: Gold Metadata (CSL-JSON)
DOI 10.1186/s13054-024-04804-7
Data confidence 85 high
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Abstract

BACKGROUND: There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions. METHODS: This was a secondary analysis of the MOSAICS II study, an international prospective observational study on sepsis epidemiology in Asian ICUs. Associations between qSOFA at ICU admission and mortality were separately assessed in LLMIC, UMIC and HIC countries/regions. Modified Poisson regression was used to determine the adjusted relative risk (RR) of qSOFA score on mortality at 28 days with adjustments for confounders identified in the MOSAICS II study. RESULTS: Among the MOSAICS II study cohort of 4980 patients, 4826 patients from 343 ICUs and 22 countries were included in this secondary analysis. Higher qSOFA was associated with increasing 28-day mortality, but this was only observed in LLMIC (p < 0.001) and UMIC (p < 0.001) and not HIC (p = 0.220) countries/regions. Similarly, higher 90-day mortality was associated with increased qSOFA in LLMIC (p < 0.001) and UMIC (p < 0.001) only. In contrast, higher 3-day mortality with increasing qSOFA score was observed across all income countries/regions (p < 0.001). Multivariate analysis showed that qSOFA remained associated with 28-day mortality (adjusted RR 1.09 (1.00-1.18), p = 0.038) even after adjustments for covariates including APACHE II, SOFA, income country/region and administration of antibiotics within 3 h. CONCLUSIONS: qSOFA was independently associated with 28-day mortality in ICU patients admitted for sepsis. In LLMIC and UMIC countries/regions, qSOFA was associated with early to late mortality but only early mortality in HIC countries/regions.