Lie Khie Chen, Lau Chuen-Yen, Van Vinh Chau Nguyen, West T Eoin, Limmathurotsakul Direk
1Department of Internal Medicine, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
2Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA.
J Intensive Care. 2018 Feb 14;6:9. doi: 10.1186/s40560-018-0279-7. eCollection 2018.
Sepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia.
We prospectively recruited hospitalized adults within 24 h of admission with community-acquired infection at nine public hospitals in Indonesia ( = 3), Thailand ( = 3), and Vietnam ( = 3). In patients with organ dysfunction (total SOFA score ≥ 2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥ 3 for an individual organ system.
From December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24 h of admission was low: broad-spectrum antibiotics in 76% (344/454), ≥ 1500 mL fluid in 50% of patients with hypotension or lactate ≥ 4 mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, < 0.001). The number of organ failures showed a significant correlation with 28-day mortality, which ranged from 7% in patients without any organ failure to 47% in those with failure of at least four organs ( < 0.001). The area under the receiver operating characteristic curve of the total SOFA score for discrimination of mortality was 0.68 (95% CI 0.62-0.74).
Community-acquired sepsis in Southeast Asia due to a variety of pathogens is usually managed outside the ICU and with poor compliance to sepsis bundles. In this population, calculation of SOFA scores is feasible and SOFA scores are associated with mortality.
ClinicalTrials.gov, NCT02157259. Registered 5 June 2014, retrospectively registered.
脓毒症是一个全球性威胁，但在东南亚地区研究不足。目的是评估东南亚社区获得性脓毒症患者的管理、结局、对脓毒症集束治疗的依从性以及最大序贯器官衰竭评估（SOFA）评分对死亡率的预测价值。
我们前瞻性地招募了印度尼西亚（3家）、泰国（3家）和越南（3家）9家公立医院入院24小时内患有社区获得性感染的住院成人患者。对于器官功能障碍患者（总SOFA评分≥2），我们分析了脓毒症的管理和结局，并评估了SOFA评分对死亡率的预测价值。器官衰竭定义为单个器官系统的最大SOFA评分≥3。
2013年12月至2015年12月，共纳入454例因多种病因导致社区获得性脓毒症的成年患者。入院24小时内对脓毒症集束治疗的依从性较低：76%（344/454）使用了广谱抗生素，低血压或乳酸≥4 mmol/L的患者中50%（115/231）补液量≥1500 mL，低血压患者中71%（135/191）使用了肾上腺素能药物。355例患者（78%）在重症监护室外接受治疗。99例患者（22%）死亡。随后死亡患者入院时的总SOFA评分显著高于存活患者（6.7对4.6，<0.001）。器官衰竭的数量与28天死亡率显著相关，从无任何器官衰竭患者的7%到至少四个器官衰竭患者的47%（<0.001）。总SOFA评分用于区分死亡率的受试者工作特征曲线下面积为0.68（95%CI 0.62 - 0.74）。
东南亚地区由多种病原体引起的社区获得性脓毒症通常在重症监护室外进行治疗，对脓毒症集束治疗的依从性较差。在该人群中，计算SOFA评分是可行的，且SOFA评分与死亡率相关。
ClinicalTrials.gov，NCT02157259。2014年6月5日注册，回顾性注册。
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