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Southern African Journal of Critical Care (Online)

On-line version ISSN 2078-676X
Print version ISSN 1562-8264


SAVARIMUTHU, S M et al. qSOFA as a predictor of ICU outcomes ina resource-limited setting in KwaZulu-Natal Province, South Africa. South. Afr. j. crit. care (Online) [online]. 2020, vol.36, n.2, pp.92-95. ISSN 2078-676X.

BACKGROUND. Sepsis is a major cause of morbidity and mortality- especially in critical care patients. Developing tools to identify patients who are at risk of poor outcomes and prolonged length of stay in intensive care units (ICUs) is critical- particularly in resource-limited settings. OBJECTIVE. To determine whether the quick sequential organ failure assessment (qSOFA) score based on bedside assessment alone was a promising tool for risk prediction in low-resource settings. METHODS. A retrospective cohort of adult patients admitted to the intensive care unit (ICU) at Edendale Hospital in Pietermaritzburg- South Africa (SA)- was recruited into the study between 2014 and 2018. The association of qSOFA with in-ICU mortality was measured using multivariable logistic regression. Discrimination was assessed using the area under the receiver operating characteristic curve and the additive contribution to a baseline model using likelihood ratio testing. RESULTS. The qSOFA scores of 0- 1 and 2 were not associated with increased odds of in-ICU mortality (adjusted odds ratio (aOR) 1.2495% confidence interval (CI) 0.86 - 1.79; p=0.26) in patients with infection- while the qSOFA of 3 was associated with in-ICU mortality in infected patients (aOR 2.82; 95% CI 1.91 - 4.16; p<0.001). On the other hand- the qSOFA scores of 2 (aOR 3.25; 95% CI 1.91 - 5.53; p<0.001) and 3 (aOR 6.26- 95% CI 0.38 - 11.62- p<0.001) were associated with increased odds of in-ICU mortality in patients without infection. Discrimination for mortality was fair to poor and adding qSOFA to a baseline model yielded a statistical improvement in both cases (p<0.001). CONCLUSIONS. qSOFA was associated with- but weakly discriminant- for in-ICU mortality for patients with and without infection in a resource-limited- public hospital in SA. These findings add to the growing body of evidence that support the use of qSOFA to deliver low-cost high-value critical care in resource-limited settings.

Keywords : sepsis; quick sequential organ failure assessment score (qSOFA); resource-limited setting; low- and middle-income countries (LMIC); global critical care.

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