Abstract
BackgroundQuick 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.MethodsRetrospective 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.ResultsAmong 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).ConclusionsAmong 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.Trial registrationClinicaltrials.gov Identifier: NCT01947075
Highlights
Fever is a frequent medical condition leading to health care seeking and hospital admission [1,2,3]
The prognostic accuracy of Quick Sequential Organ Failure Assessment (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 Systemic Inflammatory Response Syndrome (SIRS) (AUROC 0.61, 0.52–0.71; p
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
Summary
Fever is a frequent medical condition leading to health care seeking and hospital admission [1,2,3]. Identification of patients with fever who have or are at risk of sepsis is a challenge in emergency departments, especially in low-income countries where resources are limited in term of healthcare workers and laboratory facilities. In a recent prospective study conducted in emergency departments of four European countries, qSOFA had greater prognostic accuracy for in-hospital mortality than SIRS or severe sepsis, but not SOFA [7]. 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 28day all-cause mortality in febrile adults treated at the EDs in a low-income country was evaluated.
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