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Prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA)-lactate criteria for mortality in adults with suspected bacterial infection in the emergency department of a hospital with limited resources
  1. Robert Sinto1,
  2. Suhendro Suwarto1,
  3. Khie Chen Lie1,
  4. Kuntjoro Harimurti2,3,
  5. Djoko Widodo1,
  6. Herdiman T Pohan1
  1. 1 Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
  2. 2 Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
  3. 3 Clinical Epidemiology and Evidence-based Medicine Unit, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta, Indonesia
  1. Correspondence to Dr. Robert Sinto, Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital, Jakarta Pusat, DKI Jakarta 10430, Indonesia; robert.sinto01{at}ui.ac.id; rsinto{at}yahoo.com

Abstract

Background Routine use of the Sequential Organ Failure Assessment (SOFA) score to prognosticate patients with sepsis is challenged by the requirement to perform numerous laboratory tests. The prognostic accuracy of the quick SOFA (qSOFA) without or with lactate criteria has not been prospectively investigated in low and middle income countries. We assessed the performance of simplified prognosis criteria using qSOFA-lactate criteria in the emergency department of a hospital with limited resources, in comparison with SOFA prognosis criteria and systemic inflammatory response syndrome (SIRS) screening criteria.

Methods This prospective cohort study was conducted between March and December 2017 in adult patients with suspected bacterial infection visiting the emergency department of the Indonesian National Referral Hospital. Variables from sepsis prognosis and screening criteria and venous lactate concentration at enrolment were recorded. Patients were followed up until hospital discharge or death. Prognostic accuracy was measured using area under the receiver operating characteristic curve (AUROC) of each criterion in the prediction of in-hospital mortality.

Results Of 3026 patients screened, 1213 met the inclusion criteria. The AUROC of qSOFA-lactate criteria was 0.74 (95% CI 0.71 to 0.77). The AUROC of qSOFA-lactate was not statistically significantly different to the SOFA score (AUROC 0.75, 95% CI 0.72 to 0.78; p=0.462). The qSOFA-lactate was significantly higher than qSOFA (AUROC 0.70, 95% CI0.67 to 0.74; p=0.006) and SIRS criteria (0.57, 95% CI0.54 to 0.60; p<0.001).

Conclusions The prognostic accuracy of the qSOFA-lactate criteria is as good as the SOFA score in the emergency department of a hospital with limited resources. The performance of the qSOFA criteria is significantly lower than the qSOFA-lactate criteria and SOFA score.

This abstract has been translated and adapted from the original English-language content. Translated content is provided on an "as is" basis. Translation accuracy or reliability is not guaranteed or implied. BMJ is not responsible for any errors and omissions arising from translation to the fullest extent permitted by law, BMJ shall not incur any liability, including without limitation, liability for damages, arising from the translated text.

  • prognostic accuracy
  • lactate
  • qSOFA
  • sepsis
  • SIRS
  • SOFA
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Footnotes

  • Contributors Conception and design of the study: RS, SS, KCL, KH, DW, HTP. Statistical analysis: RS, SS, KH. Drafting the article: RS, SS, KCL, KH. Revising the article critically for important intellectual content: RS, SS, KCL, KH, DW. Final approval of the version to be submitted: RS, SS, KCL, KH, DW, HTP.

  • Funding This study was supported by the Operational Research Grant of Cipto Mangunkusumo National Hospital 2017. The funder had no role in design and conduct of the study, manuscript and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent for publication Written informed consent was obtained from all patients or their representatives. All subjects or their representatives were able to provide informed consent.

  • Ethics approval The Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Hospital Ethics Committee, Jakarta, Indonesia approved the study (ID of approval: 0040/UN2.F1/ETIK/2018). Written informed consent was obtained from all patients or their representatives.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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