Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study

Abstract

BackgroundSepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia.MethodsWe prospectively recruited hospitalized adults within 24 h of admission with community-acquired infection at nine public hospitals in Indonesia (n = 3), Thailand (n = 3), and Vietnam (n = 3). In patients with organ dysfunction (total SOFA score ≥ 2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥ 3 for an individual organ system.ResultsFrom December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24 h of admission was low: broad-spectrum antibiotics in 76% (344/454), ≥ 1500 mL fluid in 50% of patients with hypotension or lactate ≥ 4 mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, p < 0.001). The number of organ failures showed a significant correlation with 28-day mortality, which ranged from 7% in patients without any organ failure to 47% in those with failure of at least four organs (p < 0.001). The area under the receiver operating characteristic curve of the total SOFA score for discrimination of mortality was 0.68 (95% CI 0.62–0.74).ConclusionsCommunity-acquired sepsis in Southeast Asia due to a variety of pathogens is usually managed outside the ICU and with poor compliance to sepsis bundles. In this population, calculation of SOFA scores is feasible and SOFA scores are associated with mortality.Trial registrationClinicalTrials.gov, NCT02157259. Registered 5 June 2014, retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s40560-018-0279-7) contains supplementary material, which is available to authorized users.

Effect of a sepsis prediction algorithm on patient mortality, length of stay and readmission: a prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals

“…Results from the clinical outcomes analysis indicate that the algorithm has a more significant effect on improving clinical outcomes than other screening tools such as MEWS, SOFA and SIRS. [25][26][27][28] For example, in a prospective comparative analysis of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis, discrimination of in-hospital mortality using the SIRS score was reported to be significantly less than that of the qSOFA score, with an overall in-hospital mortality rate of 19%. 25 A pre-implementation and post-implementation study evaluating the effect of an SIRS-based sepsis early warning system that monitored SIRS criteria along with signs of organ dysfunction (based on systolic blood pressure and serum lactate thresholds), found that while the tool prompted more timely sepsis care, there was no significant reduction in mortality.…”

“…[17][18][19][20][21][22][23][24] Despite their limitations, these scoring systems have established performance metrics, and serve as important comparators for newly developed severe sepsis detection and prediction systems and their effect on clinical outcomes. [25][26][27][28] Improvement in sepsis care and adoption of electronic health record (EHR) systems have been incentivised by the Centers for Medicare & Medicaid Services in recent years. 29 30 Currently, 96% of hospitals in the USA have an EHR federally tested and certified for the government's incentive programme.…”

Clinical epidemiology and outcomes of community acquired infection and sepsis among hospitalized patients in a resource limited setting in Northeast Thailand: A prospective observational study (Ubon-sepsis)

“…arterial blood gas) due to a lack of resources. This lack of testing could lead to an underestimate of the prevalence of sepsis [ 39 , 40 ]. Second, in addition to unavailability of some data, we did not capture doses of adrenergic agents used.…”

Efficacy of HA330 Hemoperfusion Adsorbent in Patients Followed in the Intensive Care Unit for Septic Shock and Acute Kidney Injury and Treated with Continuous Venovenous Hemodiafiltration as Renal Replacement Therapy

“…Lie et al [30] reported that the overall 28-day mortality rate in patients with sepsis and severe sepsis was 22%; rates ranged from 7% for those with a SOFA score of 2 to 39% for those with scores > 6 at the time of ICU admission. Khwannimit et al [31] reported that the overall 30-day mortality rate for patients with septic shock and a SOFA score of 9 was 45.1%.…”