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

Li A. Ling L. Qin H. Arabi Y.M. Myatra S.N. Egi M. Kim J.H. Nor M.B.M. Son D.N. Fang W.-F. Wahyuprajitno B. Hashmi M. Faruq M.O. Patjanasoontorn B. Al Bahrani M.J. Shrestha B.R. Shrestha U. Nafees K.M.K. Sann K.K. Palo J.E.M. Mendsaikhan N. Konkayev A. Detleuxay K. Chan Y.H. Du B. Divatia J.V. Koh Y. Phua J.
December 2024 BioMed Central Ltd

Critical Care
2024 #28 Issue 1

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. Graphical Abstract: [Figure not available: see fulltext.]

APACHE , Critical care , Infection , Mortality , Prediction , qSOFA

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Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
State Key Laboratory of Complex, Severe and Rare Disease, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Department of Anesthesiology and Intensive Care, Kyoto University Hospital, Kyoto, Japan
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
International Islamic University Malaysia Medical Center, Kuantan, Malaysia
Center of Critical Care Medicine, Bach Mai Hospital, Hanoi Medical University, VNU University of Medicine and Pharmacy, Hanoi, Viet Nam
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Airlangga, Intensive Care Unit, Dr Soetomo General Hospital, Surabaya, Indonesia
Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
General Intensive Care Unity and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
Department of Anesthesia and Intensive Care, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
Department of Anaesthesiology and ICU, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
Mongolia Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
Anaesthesiology and Intensive Care Department, Astana Medical University, Astana, Kazakhstan
Anaesthesiology and Intensive Care Department, National Scientific Center of Traumatology and Orthopedia Named After Academician N.D. Batpenov, Astana, Kazakhstan
Adult Intensive Care Unit, Mahosot Hospital, Vientiane, Laos
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
FAST and Chronic Programmed, Alexandra Hospital, National University Health System, Singapore, Singapore

Division of Respiratory and Critical Care Medicine
Department of Anaesthesia and Intensive Care
State Key Laboratory of Complex
King Saud Bin Abdulaziz University for Health Sciences
Department of Anaesthesiology
Department of Anesthesiology and Intensive Care
Division of Pulmonary and Critical Care Medicine
International Islamic University Malaysia Medical Center
Center of Critical Care Medicine
Division of Pulmonary and Critical Care Medicine
Department of Respiratory Care
Department of Anesthesiology and Reanimation
Department of Anaesthesiology
General Intensive Care Unity and Emergency Department
Division of Respiratory and Critical Care Medicine
Department of Anesthesia and Critical Care
Department of Anesthesia and Intensive Care
RIPAS Hospital
Department of Anaesthesiology and ICU
Acute and Critical Care Institute
Mongolia Japan Hospital
Anaesthesiology and Intensive Care Department
Anaesthesiology and Intensive Care Department
Adult Intensive Care Unit
Biostatistics Unit
Department of Pulmonary and Critical Care Medicine
FAST and Chronic Programmed

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