Predictive Validity of the qSOFA Score for Sepsis in Adults with Community-Onset Staphylococcal Infection in Thailand.

Supaksh Gupta,Derek C Angus,Sharon J Peacock,Pornpan Suntornsut,Kristina E Rudd,Timothy Eoin West,Ploenchan Chetchotisakd,Sarunporn Tandhavanant,Narisara Chantratita

doi:10.3390/jcm8111908

Abstract

The quick sequential organ failure assessment (qSOFA) score has had limited validation in lower resource settings and was developed using data from high-income countries. We sought to evaluate the predictive validity of the qSOFA score for sepsis within a low- and middle-income country (LMIC) population with culture-proven staphylococcal infection. This was a secondary analysis of a prospective multicenter cohort in Thailand with culture-positive infection due to Staphylococcus aureus or S. argenteus within 24 h of admission and positive (≥2/4) systemic inflammatory response syndrome (SIRS) criteria. Primary exposure was maximum qSOFA score within 48 h of culture collection and primary outcome was mortality at 28 days. Baseline risk of mortality was determined using a multivariable logistic regression model with age, gender, and co-morbidities significantly associated with the outcome. Predictive validity was assessed by discrimination of mortality using area under the receiver operating characteristic (AUROC) curve compared to a model using baseline risk factors alone. Of 253 patients (mean age 54 years (SD 16)) included in the analysis, 23 (9.1%) died by 28 days after enrollment. Of those who died, 0 (0%) had a qSOFA score of 0, 8 (35%) had a score of 1, and 15 (65%) had a score ≥2. The AUROC of qSOFA plus baseline risk was significantly greater than for the baseline risk model alone (AUROCqSOFA = 0.80 (95% CI, 0.70–0.89), AUROCbaseline = 0.62 (95% CI, 0.49–0.75); p < 0.001). Among adults admitted to four Thai hospitals with community-onset coagulase-positive staphylococcal infection and SIRS, the qSOFA score had good predictive validity for sepsis.

Highlights

Sepsis, a significant cause of morbidity and mortality worldwide, disproportionately affects individuals from low- and middle-income countries (LMICs) [1]
Of the 327 patients with staphylococcal infection identified by the hospital microbiology laboratories in the original study, 74 patients were excluded from the final analysis
Of the 239 subjects whose bacterial isolates were obtained for genetic analysis, 189/239 (79%) were confirmed to be S. aureus and 50/239 (21%) were reclassified as S. argenteus

Summary

Introduction

A significant cause of morbidity and mortality worldwide, disproportionately affects individuals from low- and middle-income countries (LMICs) [1]. In 2016, the Sepsis-3 Task Force met to update the definition of sepsis to better reflect the current pathobiologic understanding of sepsis and the overemphasis of the prior definition on inflammation [11]. The ‘quick’ SOFA (qSOFA) score was proposed by the Sepsis-3 Task Force as a tool to assist in early identification of patients at risk of sepsis [9]. The qSOFA score was created using retrospective statistical analysis of cohorts exclusively from high-income countries (HIC) [11]. No studies have reported the performance of qSOFA among patients in LMICs with documented staphylococcal infection

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