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

Andrew Li; Lowell Ling; Hanyu Qin; Yaseen M Arabi; Sheila Nainan Myatra; Moritoki Egi; Je Hyeong Kim; Mohd Basri Mat Nor; Do Ngoc Son; Wen-Feng Fang; Bambang Wahyuprajitno; Madiha Hashmi; Mohammad Omar Faruq; Boonsong Patjanasoontorn; Maher Jaffer Al Bahrani; Babu Raja Shrestha; Ujma Shrestha; Khalid Mahmood Khan Nafees; Kyi Kyi Sann; Jose Emmanuel M Palo; Naranpurev Mendsaikhan; Aidos Konkayev; Khamsay Detleuxay; Yiong Huak Chan; Bin Du; Jigeeshu Vasishtha Divatia; Younsuck Koh; Jason Phua; MOSAICS II Study Group; Asian Critical Care Clinical Trials Group

doi:10.1186/s13054-024-04804-7

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

Crit Care. 2024 Jan 23;28(1):30. doi: 10.1186/s13054-024-04804-7.

Authors

Andrew Li¹, Lowell Ling², Hanyu Qin³, Yaseen M Arabi⁴, Sheila Nainan Myatra⁵, Moritoki Egi⁶, Je Hyeong Kim⁷, Mohd Basri Mat Nor⁸, Do Ngoc Son⁹, Wen-Feng Fang^{10

11}, Bambang Wahyuprajitno¹², Madiha Hashmi¹³, Mohammad Omar Faruq¹⁴, Boonsong Patjanasoontorn¹⁵, Maher Jaffer Al Bahrani¹⁶, Babu Raja Shrestha¹⁷, Ujma Shrestha¹⁷, Khalid Mahmood Khan Nafees¹⁸, Kyi Kyi Sann¹⁹, Jose Emmanuel M Palo²⁰, Naranpurev Mendsaikhan²¹, Aidos Konkayev^{22

23}, Khamsay Detleuxay²⁴, Yiong Huak Chan²⁵, Bin Du³, Jigeeshu Vasishtha Divatia⁵, Younsuck Koh²⁶, Jason Phua^{1

27}; MOSAICS II Study Group; Asian Critical Care Clinical Trials Group

Collaborators

Uzzal Kumar Mallick, Motiul Islam, Tarequl Hamid, A K M Shirazul Islam, Rabiul Halim, Md Arifur Rahman Khan, Mohammad Asaduzzaman, Md Rezaul Karim, Nahim Sarwar, Shamsul Hoque Milon, Rashed Mahmud, A K M Sirajul Islam Hirok, Ashraful Haque, Amina Sultana, Mir Atiqur Rahman Shajal, Farha Andalib, Rashedul Hasan, Khalid Mahmood Khan Nafees, Shah Sudhirchandra Dhansukhlal, Ning Li, Xiaowei Liu, Haiwei Yang, Ming Hou, Ying Li, Jian Zhang, Lifeng Huang, Wenxiong Li, Meili Duan, Taotao Liu, Wei He, Fangyu Ning, Xiaozhi Wang, Xiaoyan Zhou, Sun Yu, Xiang Xiang, Liang Pan, Feihu Zhou, Yaoli Wang, Jian Zhou, Tao Wang, Xuefei Yang, Yu Ma, Xuan Song, Haiying Wu, Chuanyun Qian, Lixin Zhou, Zuohang Xu, Kun Zhang, Zhenjie Hu, Xingsheng Lin, Songjing Shi, Xiaoguang Zhang, Rongguo Yu, Liqin Zhang, Yuan Yuan, Huiru Zhou, Xiandong Wang, Zhonghua Wang, Tiehe Qin, Xianqing Shi, Rui Li, Zhenyang He, Xiangrong Zuo, Quan Cao, Tao He, Yuanda Sui, Tiejun Wu, Ying Xu, Qin Gu, Weizheng Shuai, Hanyu Qin, Bin Du, Hong Qiao, Shuangling Li, Guiying Dong, Xiujuan Zhao, Fengxue Zhu, Junshi Wang, Lei Huang, Tianchang Wang, Hao Wang, Siqing Ma, Zhengping Yang, Yuan Gao, Ruoming Tan, Yun Xie, Ruilan Wang, Jia Jia, Bin Zang, Jun Wang, Ling Lin, Yuwen Wu, Yunfu Wu, Penglin Ma, Yanfang Li, Li Yu, Rui Guo, Jiuzhi Zhang, Xianyao Wan, Feng Shen, Qindong Shi, Jun Xu, Qiang Fang, Shaohua Liu, Tongwen Sun, Mian Zeng, Weiyun Pan, Zhongmin Liu, Qingling Lin, Nan Wang, Jing Pang, Bin Xiong, Deliang Wen, Fuxin Kang, Liuhui Chang, Yun Sun, Jingxiao Zhang, Yongjie Yin, Liu Qing, Jiajun Sun, Nahui Li, Yongqiang Wang, Songtao Shou, Yanfen Chai, Lei Xu, Xiaobo Yang, Xuelian Liao, Xian Kang, Shuangping Zhao, Liquan Huang, Run Zhang, Renhua Sun, Chao Shen, Yan He, Fu Loi Chow, Michele Tang, Philip Lam, Esther Cham, Kin Bong Tang, Lowell Ling, Manimala Dharmangadan, Pauline Yeung Ng, Kin Ho Ling, Vincent Lau, Samir Sahu, Sharmila Chatterjee, Sushmita Basu, Zubair Umer Mohamed, Sudeep Sirga, Siddhartha Reddy Kasireddy, M A Aleem, Swarna Deepak Kuragayala, Sai Praveen Haranath, Nagarajan Ramakrishnan, Pravin Amin, Joanne Mascarenhas, Radhika Dash, Venkat Raman Kola, R Vaidyanathan, Siddharth Agarwal, Pradip K Bhattacharya, Deepak Jeswani, Parshotum Lal Gautam, Abdul Samad Ansari, Vivek Nangia, Mrinal Sircar, V M Balasubramani, S Maneendra, Sanghamitra Mishra, Anjeev Kumar, Rajesh Chawla, Trevor Francis Sequeira, Om Prakash Shrivastava, T V Sreevalsan, Rajesh Mohan Shetty, Manjunath Thimmappa, M M Harish, Yatin Mehta, Divya Saxena, Vipul Mishra, Rishi Kumar, Simnt Kumar Jha, Prashant Sakhavalkar, Dnyaneshwar Diwane, Subhal Dixit, Kalaiselvan, Manoranjan Pattnaik, Lalit Singh, Fareed Khan, Mehul Shah, Prasanna, Ziokov Joshi, Sheila Ninan Myatra, Manoj Gorade, Bharat G Jagiasi, Amol Hartalkar, B Saroj Kumar Prusty, Yogesh, Ade Winata, Maulydia, Surya Oto Wijaya, Hermin Prihartini, Shinta V R Hutajulu, Rudy Manalu, Christrijogo Sumartono, Chrisma Adryana Albandjar, Ira Pitaloka, Dewi Kusumawati, Arifin, Akhmad Yun Jufan, Bambang Pujo Semedi, Vanessy Theodora Silalahi, Yudianto, Erwin Pradian, Achsanuddin Hanafie, Mariza Fitriati, Tinni Trihartini Maskoen, Satriawan Abadi, Calcarina Fitriani Retno Wisudarti, Johan Arifin, Reza Widyanto Sudjud, Prananda Surya Airlangga, Rupi'i, I Made Wiryana, Anang Achmadi, Patra Rijalul Harly, Edward Kusuma, Primartanto Wibowo, Ade Veronica Hy, Jeni Sarah Mandang, Meriwijanti, I Wayan Aryabiantara, Faisal Muchtar, Fachrul Jamal Isa, Dita Aditianingsiih, Nicolaas Parningotan Simamora, Moch Hasyim, I Gusti Putu Manuaba, Novita Anggraeni, Rudy Ariyanto Sanoesi, Arief Munandar, Duma Saurma Siahaan, Sri Rachmawati, Oky Susianto, Liliriawati Ananta Kahar, Zulkifli, Mordekhai Leopold Laihad, Nakada Takaaki, Yoshitaka Hara, Osamu Nishida, Kenji Uehara, Makoto Takatori, Shinichiro Ohshimo, Kazuya Kikutani, Nobuaki Shime, Shin Nunomiya, Shinshu Katayama, Bengo Atari, Takashi Ito, Yasuyuki Kakihana, Kohei Takimoto, Machi Yanai, Moritoki Egi, Tomoaki Yatabe, Yuki Kishiara, Ushio Higashijima, Motohiro Sekino, Kazuaki Atagi, Hiroshi Ogura, Tsunehiro Matsubara, Tadashi Kamio, Shigeki Fujitani, Toru Yoshida, Yukari Aoyagi, Shigehiko Uchino, Masatsugu Hasegawa, Jun Oto, Naoki Yamaguchi, Yuki Enomoto, Masaki Nakane, G S Amirova, Murat Daribaev, Markov Viktor Evgenievich, A A Vorobiev, A V Andrushenko, Aliya Torpakbaeva, M E Konkayeva, A V Galkin, P A Ostanin, Khamsay Detleuxay, Noryani Mohd Samat, Ismail Tan, Nahla Irtiza Ismail, Chew Har Lim, Wan Nasrudin Wan Ismail, Siti Rohayah Sulaiman, Anita Alias, Joanne Tiong Jia Wen, Azmin Huda Abdul Rahim, Asmah Zainudin, Nik Azman Nik Adib, Zihni Abdullah, Hafizah, Mohd Zulfakar Mazlan, Mohd Basri Mat Nor, Munkhasiakhan, Naranpurev, Cho Myint Tun, Thinzar Maw, Cho Cho, Han Sein, Myo Malar Win, Lwin Lwin Hnin, Cho Cho Lwin, Aye Su Mon, Yi Sandar Thein, Khin Le Le Yi, Myo Min Naing, Nu Nu May, Lun Naing, Khin Saw Yu Aung, Moe Thu Lin, Aung Kyi, Kyaw Min Min Tun, Suu New Khin, Khin Pyone Yi, Khin May Waan, Moe Thidar, Kyi Kyi Sann, Mu Mu Naing, Win Win Mar, Naing Naing Lin, Lalit Rajbanshi, Trishant Limbu, Baburaja Shrestha, Ujma Shrestha, Ashish Shrestha, Rosi Pradhan, Ravi Ram Shrestha, Sulav Acharya, Pramesh Sunder Shrestha, Puja Thapa Karki, Moosa Awladthani, Jacob Paul, Nadia Al Badi, Adil Al Kharusi, Khalil Al Kharousi, Sandeep Kantor, Yohannan John, Said Al Mandhari, Geetha Jacob, Amr Muhammad Esmat, B M J Shetty, Ahmed Mostafa, Naveed Haroon Rashid, Muhammad Sohaib, Sonia Joseph, Safia Zafar, Ahmed Farooq, Muhammad Sheharyar Ashraf, Tanveer Hussain, Muhammad Hayat, Ataur Rehman, Syed Muneeb Ali, Saad Ur Rehman, Ashok Kumar, Aaron Hernandez, Crystal Aperocho, Raymundo Resurreccion, Debbie Noblezada-Uy, Jose Emmanuel Palo, Julie Visperas, Amer Asiri, Ali Beshabshi, Fahad Al-Hameed, Ohoud Al Orabi, Yaseen Arabi, Eman Al Qasim, Masood Iqbal, Tharwat Aisa, Mohammed Saeed Al Shahrani, Laila Asonto, Ayman Kharaba, Abdullah Al Mutairi, Khaild Al Ghamdi, Lama Hefni, Ahmad Al Qurashi, Galeb Al Makhlafi, Roshni Sadashiv Gokhale, Noelle Lim, Manjit Pawar, Venkatesan Kumaresh, Naville Chia Chi Hock, Tan Chee Keat, Tan Rou An, Jared De Souza, Andrew Li, Yip Hwee Seng, Jason Phua, Addy Tan Yh, Melvin Tay Chee Kiang, Ng Shin Yi, Ho Vui Kian, Kiran Sharma, Sennen Lew, Lee Rui Min, Do Wan Kim, Yoon Mi Shin, Song-I Lee, Kyung Chan Kim, Yun-Seong Kang, Soo Hwan Lee, Ho Cheol Kim, Yun Su Sim, Sunghoon Park, Tai Sun Park, Hongyeul Lee, Youjin Chang, Heung Bum Lee, Je Hyeong Kim, Young Seok Lee, Won Gun Kwack, In Byung Kim, Tae Yun Park, Young Jae Cho, Sang-Min Lee, Kyeongman Jeon, Jongmin Lee, Shin Young Kim, Jin-Won Huh, Jong Joon Ahn, Jae Hwa Cho, Won-Yeon Lee, Chin-Kuo Lin, Chang-Ke Chu, Jiun-Ting Wu, Chiung-Yu Lin, Yu-Mu Chen, Kuo-Tung Huang, Han-Chung Hu, Cong-Tat Cia, Jung-Yien Chien, Chun-Te Huang, Pin-Kuei Fu, Nattachai Srisawas, Manasnun Kongwibulwut, Kaweesak Chittawatanarat, Worapot Daewtrakulchai, Anakapong Phunmanee, Anupol Panitchote, Boonsong Patjanasoontorn, Chaiwut Sawawiboon, Lê Minh Trung, Đỗ Ngọc Sơn, B S Bùi Nhật Hà, Dương Thiện Phước, Huỳnh Quang Đại, Nguyễn Tấn Hùng, Lê Thị Phương Thúy, Hoàng Bùi Hải, Hoàng Trọng Ái Quốc, Trần Hoài Linh, Vũ Hải Yến, Phạm Trà Giang, Nguyễn Thị Ngà, Nguyễn Đăng Tuân

Affiliations

¹ Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.
² Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China. lowell.ling@cuhk.edu.hk.
³ State Key Laboratory of Complex, Severe and Rare Disease, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
⁴ King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
⁵ Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
⁶ Department of Anesthesiology and Intensive Care, Kyoto University Hospital, Kyoto, Japan.
⁷ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
⁸ International Islamic University Malaysia Medical Center, Kuantan, Malaysia.
⁹ Center of Critical Care Medicine, Bach Mai Hospital, Hanoi Medical University, VNU University of Medicine and Pharmacy, Hanoi, Vietnam.
¹⁰ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
¹¹ Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
¹² Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Airlangga, Intensive Care Unit, Dr Soetomo General Hospital, Surabaya, Indonesia.
¹³ Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
¹⁴ General Intensive Care Unity and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh.
¹⁵ Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
¹⁶ Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman.
¹⁷ Department of Anesthesia and Intensive Care, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
¹⁸ RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam.
¹⁹ Department of Anaesthesiology and ICU, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar.
²⁰ Acute and Critical Care Institute, The Medical City, Pasig City, Philippines.
²¹ Mongolia Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
²² Anaesthesiology and Intensive Care Department, Astana Medical University, Astana, Kazakhstan.
²³ Anaesthesiology and Intensive Care Department, National Scientific Center of Traumatology and Orthopedia Named After Academician N.D. Batpenov, Astana, Kazakhstan.
²⁴ Adult Intensive Care Unit, Mahosot Hospital, Vientiane, Lao PDR.
²⁵ Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²⁶ Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
²⁷ FAST and Chronic Programmed, Alexandra Hospital, National University Health System, Singapore, Singapore.

Abstract

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.

Keywords: APACHE; Critical care; Infection; Mortality; Prediction; qSOFA.

Publication types

Observational Study

MeSH terms

APACHE
Humans
Intensive Care Units
Organ Dysfunction Scores*
Prognosis
Prospective Studies
Sepsis*