The Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score can identify patients with suspected infection who are at a higher risk for excess hospital mortality in low- and middle-income countries (LMICs), according to a new study published in JAMA.

Sepsis leads to 5 million deaths annually, with the highest burden in LMICs, but there is no reference standard that allows for a simple and accurate diagnosis of sepsis. The qSOFA requires only a physical examination and can be of value in settings of limited resources. In the current study, qSOFA was evaluated in LMIC settings and compared with the systemic inflammatory response syndrome criteria.

The authors conducted a retrospective secondary analysis of 8 cohort studies and 1 randomized clinical trial that included 6569 hospitalized adults with suspected infection in emergency departments, inpatient wards, and intensive care units of 17 hospitals in 10 LMICs across 3 continents. 

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A high qSOFA score vs a low/moderate score was associated with an increased risk for death overall (19% vs 6%; difference, 13% [95% CI, 11%-14%]; odds ratio, 3.6 [95% CI, 3.0-4.2]). This result was observed for 8 of 9 cohorts (P <.05). A moderate qSOFA score vs a low score was also associated with an increase in mortality risk (8% vs 3%; difference, 5% [95% CI, 4%-6%]; odds ratio, 2.8 [95% CI, 2.0-3.9]), but this was observed in only 2 of 7 cohorts (P <.05) The odds ratio for hospital mortality, when comparing patients with a high vs low or moderate score was higher overall for qSOFA vs systemic inflammatory response syndrome (qSOFA: OR, 3.6 [95% CI, 3.0-4.2]; hospital mortality, 19% vs 6%; difference, 13% [95% CI, 11%-14%] vs systemic inflammatory response syndrome: OR, 1.7 [95% CI, 1.4-2.0]).

The authors conclude that although the qSOFA score was effective at identifying risk for death beyond that explained by baseline factors, “the predictive validity varied among cohorts and settings, and further research is needed to better understand potential generalizability.”

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Rudd KE, Seymour CW, Aluisio AR, et al. Association of the quick sequential (sepsis-related) organ failure assessment (qSOFA) score with excess hospital mortality in adults with suspected infection in low- and middle-income countries. JAMA. 2018;319(21):2202-2211.