Predictive Accuracy of the Quick Sepsis-related Organ Failure Assessment Score in Brazil. A Prospective Multicenter Study

dc.creatorMachado, Flavia R.
dc.creatorCavalcanti, Alexandre B.
dc.creatorMonteiro, Mariana B.
dc.creatorSousa, Juliana L.
dc.creatorBossa, Aline
dc.creatorBafi, Antonio T.
dc.creatorDal-Pizzol, Felipe
dc.creatorFreitas, Flavio G. R.
dc.creatorLisboa, Thiago
dc.creatorWestphal, Glauco A.
dc.creatorJapiassu, Andre M.
dc.creatorAzevedo, Luciano C. P.
dc.date2020-06-04T21:22:50Z
dc.date2020-06-04T21:22:50Z
dc.date2020
dc.date.accessioned2023-09-26T20:38:14Z
dc.date.available2023-09-26T20:38:14Z
dc.identifierMACHADO, Flavia R. et al. Predictive Accuracy of the Quick Sepsis-related Organ Failure Assessment Score in Brazil. A Prospective Multicenter Study. American Journal of Respiratory and Critical Care Medicine, v. 201, n. 7, p. 789-798, 2020.
dc.identifier1073-449X
dc.identifierhttps://www.arca.fiocruz.br/handle/icict/41545
dc.identifier10.1164/rccm.201905-0917OC
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/8861063
dc.descriptionAndre Miguel Japiassú. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Centro de Terapia Intensiva. Rio de Janeiro, RJ, Brasil. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.
dc.descriptionRationale: Although proposed as a clinical prompt to sepsis based on predictive validity for mortality, the Quick Sepsis-related Organ Failure Assessment (qSOFA) score is often used as a screening tool, which requires high sensitivity.Objectives: To assess the predictive accuracy of qSOFA for mortality in Brazil, focusing on sensitivity.Methods: We prospectively collected data from two cohorts of emergency department and ward patients. Cohort 1 included patients with suspected infection but without organ dysfunction or sepsis (22 hospitals: 3 public and 19 private). Cohort 2 included patients with sepsis (54 hospitals: 24 public and 28 private). The primary outcome was in-hospital mortality. The predictive accuracy of qSOFA was examined considering only the worst values before the suspicion of infection or sepsis.Measurements and Main Results: Cohort 1 contained 5,460 patients (mortality rate, 14.0%; 95% confidence interval [CI], 13.1-15.0), among whom 78.3% had a qSOFA score less than or equal to 1 (mortality rate, 8.3%; 95% CI, 7.5-9.1). The sensitivity of a qSOFA score greater than or equal to 2 for predicting mortality was 53.9% and the 95% CI was 50.3 to 57.5. The sensitivity was higher for a qSOFA greater than or equal to 1 (84.9%; 95% CI, 82.1-87.3), a qSOFA score greater than or equal to 1 or lactate greater than 2 mmol/L (91.3%; 95% CI, 89.0-93.2), and systemic inflammatory response syndrome plus organ dysfunction (68.7%; 95% CI, 65.2-71.9). Cohort 2 contained 4,711 patients, among whom 62.3% had a qSOFA score less than or equal to 1 (mortality rate, 17.3%; 95% CI, 15.9-18.7), whereas in public hospitals the mortality rate was 39.3% (95% CI, 35.5-43.3).Conclusions: A qSOFA score greater than or equal to 2 has low sensitivity for predicting death in patients with suspected infection in a developing country. Using a qSOFA score greater than or equal to 2 as a screening tool for sepsis may miss patients who ultimately die. Using a qSOFA score greater than or equal to 1 or adding lactate to a qSOFA score greater than or equal to 1 may improve sensitivity.
dc.description2021-06-01
dc.formatapplication/pdf
dc.languageeng
dc.publisherAmerican Thoracic Society
dc.rightsrestricted access
dc.subjectQuick Sepsis-related Organ Failure Assessment
dc.subjectSepsis-related Organ Failure Assessment
dc.subjectOrgan dysfunction
dc.subjectSepsis
dc.subjectSystemic inflammatory response syndrome
dc.titlePredictive Accuracy of the Quick Sepsis-related Organ Failure Assessment Score in Brazil. A Prospective Multicenter Study
dc.typeArticle


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