Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country - 07/08/18

Doi : 10.1016/j.ajem.2018.03.014

Adam R. Aluisio, MD, MSc ^a,^{^⁎} , Stephanie Garbern, MD, MPH ^a, Tess Wiskel, MD ^a, Zeta A. Mutabazi, MBBS ^b, Olivier Umuhire, MBBS ^c, Chin Chin Ch'ng, BPharm ^d, Kristina E. Rudd, MD ^e, Jeanne D'Arc Nyinawankusi, RN, MBA ^f, Jean Claude Byiringiro, MMed, MCh ^b, Adam C. Levine, MD, MPH ^a
^a Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
^b University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
^c Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
^d Brown University School of Public Health, Providence, USA
^e Department of Medicine, University of Washington, Seattle, USA
^f Service d'Aide Médicale Urgente, Kigali, Rwanda

^⁎Corresponding author at: Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick Street, Room 274, Providence, RI 02903, USA.Department of Emergency MedicineWarren Alpert Medical School of Brown University55 Claverick Street, Room 274ProvidenceRI02903USA

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Abstract

Objective

To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting.

Methods

This retrospective cohort study was carried out at a tertiary-care hospital, in Kigali, Rwanda and included patients ≥15years, presenting for ED care during 2013 with an infectious disease (ID). ED and overall hospital mortality were evaluated using multivariable regression, with qSOFA scores as the primary predictor (reference: qSOFA=0), to yield adjusted relative risks (aRR) with 95% confidence intervals (CI). Analyses were performed for the overall population and stratified by HIV status.

Results

Among 15,748 cases, 760 met inclusion (HIV infected 197). The most common diagnoses were malaria and intra-abdominal infections. Prevalence of ED and hospital mortality were 12.5% and 25.4% respectively. In the overall population, ED mortality aRR was 4.8 (95% CI 1.9–12.0) for qSOFA scores equal to 1 and 7.8 (95% CI 3.1–19.7) for qSOFA scores ≥2. The aRR for hospital mortality in the overall cohort was 2.6 (95% 1.6–4.1) for qSOFA scores equal to 1 and 3.8 (95% 2.4–6.0) for qSOFA scores ≥2. For HIV infected cases, although proportional mortality increased with greater qSOFA score, statistically significant risk differences were not identified.

Conclusion

The qSOFA score provided risk stratification for both ED and hospital mortality outcomes in the setting studied, indicating utility in sepsis care in SSA, however, further prospective study in high-burden HIV populations is needed.

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Abbreviations : aRR, AUC, CV, CNS, CKD, CI, DM, ED, GU, GCS, HICs, IVF, ICU, IRR, IQR, LMICs, mmHg, qSOFA, RR, SSA, SBP, TB, UTH-K

Keywords : Sepsis, qSOFA, HIV, Mortality, Emergency care, Rwanda, Africa

Plan

Introduction

Materials and methods

Study design, setting and population

Data management

Data analysis

Results

Characteristics of the study population

Mortality outcomes by qSOFA scores

Diagnostic characteristics

Sensitivity and validity analyses

Discussion

Funding

Declarations of interest

☆	Prior presentations: Preliminary results from this work were presented at the Society for Academic Emergency Medicine meeting, Indianapolis, USA. 15–18 May 2018.