Journal Article

Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country

Mutabazi, Zeta A., Rudd, Kristina E., Ch'ng, Chin Chin, Umuhire, Olivier, D'Arc Nyinawankusi, Jeanne, Wiskel, Tess, Byiringiro, Jean Claude, Levine, Adam C., Aluisio, Adam R., Garbern, Stephanie

2018

Overview

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. 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. 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. 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.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Africa / Blood pressure / Coma / Confidence intervals / Data analysis / Data collection / Developing Countries / Diabetes / Emergency care / Emergency medical care / Emergency Service, Hospital - statistics & numerical data / Emergency Treatment - mortality / Female / HIV / HIV Infections - mortality / Hospital Mortality / Hospitals / Human immunodeficiency virus / Humans / Infections / Infectious diseases / Intraabdominal Infections - mortality / Kidney diseases / Laboratories / Low income areas / Malaria / Medical records / Medicine / Middle Aged / Mortality / Multiple Chronic Conditions - mortality / Organ Dysfunction Scores / Patients / Population / Population studies / Public health / qSOFA / Retrospective Studies / Risk Assessment / Rwanda / Rwanda - epidemiology / Sepsis / Sepsis - mortality / Statistical analysis / Tertiary Care Centers / Underserved populations / Vector-borne diseases