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Open AccessArticle

Predictive Validity of the qSOFA Score for Sepsis in Adults with Community-Onset Staphylococcal Infection in Thailand

1
Department of Medicine, University of Washington, Seattle, WA 98195, USA
2
Division of Pulmonary, Sleep, and Critical Care Medicine, University of Washington, Seattle, WA 98195, USA
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Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
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Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand
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Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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Department of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
7
Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1908; https://doi.org/10.3390/jcm8111908
Received: 13 October 2019 / Revised: 28 October 2019 / Accepted: 31 October 2019 / Published: 7 November 2019
The quick sequential organ failure assessment (qSOFA) score has had limited validation in lower resource settings and was developed using data from high-income countries. We sought to evaluate the predictive validity of the qSOFA score for sepsis within a low- and middle-income country (LMIC) population with culture-proven staphylococcal infection. This was a secondary analysis of a prospective multicenter cohort in Thailand with culture-positive infection due to Staphylococcus aureus or S. argenteus within 24 h of admission and positive (≥2/4) systemic inflammatory response syndrome (SIRS) criteria. Primary exposure was maximum qSOFA score within 48 h of culture collection and primary outcome was mortality at 28 days. Baseline risk of mortality was determined using a multivariable logistic regression model with age, gender, and co-morbidities significantly associated with the outcome. Predictive validity was assessed by discrimination of mortality using area under the receiver operating characteristic (AUROC) curve compared to a model using baseline risk factors alone. Of 253 patients (mean age 54 years (SD 16)) included in the analysis, 23 (9.1%) died by 28 days after enrollment. Of those who died, 0 (0%) had a qSOFA score of 0, 8 (35%) had a score of 1, and 15 (65%) had a score ≥2. The AUROC of qSOFA plus baseline risk was significantly greater than for the baseline risk model alone (AUROCqSOFA = 0.80 (95% CI, 0.70–0.89), AUROCbaseline = 0.62 (95% CI, 0.49–0.75); p < 0.001). Among adults admitted to four Thai hospitals with community-onset coagulase-positive staphylococcal infection and SIRS, the qSOFA score had good predictive validity for sepsis. View Full-Text
Keywords: sequential organ failure assessment scores; sepsis; systemic inflammatory response syndrome; Thailand; Staphylococcus sequential organ failure assessment scores; sepsis; systemic inflammatory response syndrome; Thailand; Staphylococcus
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Gupta, S.; Rudd, K.E.; Tandhavanant, S.; Suntornsut, P.; Chetchotisakd, P.; Angus, D.C.; Peacock, S.J.; Chantratita, N.; West, T.E. Predictive Validity of the qSOFA Score for Sepsis in Adults with Community-Onset Staphylococcal Infection in Thailand. J. Clin. Med. 2019, 8, 1908.

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