Journal Article

Prognostic value of quickSOFA as a predictor of 28-day mortality among febrile adult patients presenting to emergency departments in Dar es Salaam, Tanzania

Mamin, Aline, Kaiser, Laurent, Mbarack, Zainab, D’Acremont, Valérie, Calandra, Thierry, Boillat-Blanco, Noémie, Samaka, Josephine, Mlaganile, Tarsis, Genton, Blaise

2018

Overview

Quick Sequential Organ Failure Assessment (qSOFA) is a three-item clinical instrument for bedside identification of sepsis patients at risk of poor outcome. qSOFA could be a valuable triage tool in emergency departments of low-income countries, yet its performance in resource-limited settings remains unknown. The prognostic accuracy of qSOFA for 28-day all-cause mortality in febrile adults treated at the EDs in a low-income country was evaluated. Retrospective analysis of a prospective cohort study of consecutive patients (≥18 years) with fever (tympanic temperature ≥38°C and fever ≤7 days) who presented between July 2013 and May 2014 at four emergency departments in Dar es Salaam, Tanzania. Medical history, clinical examination, laboratory and microbiological data were collected to document the cause of fever. Variables for the previous and new sepsis criteria were collected at inclusion and qSOFA, SOFA and SIRS were measured at inclusion. Patients were followed up by phone at day 28. The performance (sensitivity, specificity and area under the receiver operating curve [AUROC]) of qSOFA (score ≥2), SOFA (increase of ≥2 points) and SIRS (≥2 criteria) as predictors of 28-day all-cause mortality was evaluated. Among the 519 patients (median age: 30 years) included in the analysis, 47% were female and 25% were HIV positive. Overall, 85% had a microbiologically and/or clinically documented infection and 15% a fever of unknown origin. The most common site and causes of infections were the respiratory tract (43%), dengue (26%), malaria (6%) and typhoid fever (5%). Twenty-eight-day all-cause mortality was 6%: 3% for patients with a qSOFA <2 and 24% for those with a score ≥2 (absolute difference, 21%; 95% CI 12%-31%). The prognostic accuracy of qSOFA (AUROC 0.80, 95% CI 0.73-0.87) for 28-day mortality was similar to SOFA (AUROC 0.79, 0.71-0.87; p = 0.1) and better than SIRS (AUROC 0.61, 0.52-0.71; p<0.001). Among patients with fever at emergency departments in Tanzania, qSOFA had a prognostic accuracy for 28-day mortality comparable to SOFA and superior to SIRS. These results support the use of qSOFA as a triage tool to identify patients with sepsis and at risk of poor outcome in resource-limited countries. Clinicaltrials.gov Identifier: NCT01947075.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Accuracy / Adult / Adults / Ambulatory care / Biology and Life Sciences / Blood pressure / Care and treatment / Critical care / Critically ill persons / Dengue / Dengue fever / Departments / Emergency medical services / Emergency Service, Hospital - statistics & numerical data / Female / Fever / Fever - diagnosis / Fever - mortality / Hospitals / Humans / Income / Infections / Infectious diseases / Intensive care / Laboratories / Low income areas / Low income groups / Malaria / Male / Medical prognosis / Medicine / Medicine and Health Sciences / Methods / Mortality / Organ Dysfunction Scores / Outcome and process assessment (Medical care) / Patient outcomes / Patients / Prognosis / Public health / Respiratory tract / Respiratory tract diseases / Retrospective Studies / Sepsis / Singers / Tanzania / Typhoid / Typhoid fever / Vector-borne diseases / Viral diseases / Virology / Water-borne diseases / Waterborne diseases / Young Adult