Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam.
Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam.
BMC Infect Dis. 2018 Oct 26;18(1):535. doi: 10.1186/s12879-018-3448-3.
Community acquired bloodstream infection (CABSI) in low- and middle income countries is associated with a high mortality. This study describes the clinical manifestations, laboratory findings and correlation of SOFA and qSOFA with mortality in patients with CABSI in northern Vietnam.
This was a retrospective study of 393 patients with at least one positive blood culture with not more than one bacterium taken within 48 h of hospitalisation. Clinical characteristic and laboratory results from the first 24 h in hospital were collected. SOFA and qSOFA scores were calculated and their validity in this setting was evaluated.
Among 393 patients with bacterial CABSI, approximately 80% (307/393) of patients had dysfunction of one or more organ on admission to the study hospital with the most common being that of coagulation (57.1% or 226/393). SOFA performed well in prediction of mortality in those patients initially admitted to the critical care unit (AUC 0.858, 95%CI 0.793-0.922) but poor in those admitted to medical wards (AUC 0.667, 95%CI 0.577-0.758). In contrast qSOFA had poor predictive validity in both settings (AUC 0.692, 95%CI 0.605-0.780 and AUC 0.527, 95%CI 0.424-0.630, respectively). The overall case fatality rate was 28%. HIV infection (HR = 3.145, p = 0.001), neutropenia (HR = 2.442, p = 0.002), SOFA score 1-point increment (HR = 1.19, p < 0.001) and infection with Enterobacteriaceae (HR = 1.722, p = 0.037) were independent risk factors for in-hospital mortality.
Organ dysfunction was common among Vietnamese patients with CABSI and associated with high case fatality. SOFA and qSOFA both need to be further validated in this setting.
在中低收入国家，社区获得性血流感染（CABSI）与高死亡率相关。本研究描述了越南北部 CABSI 患者的临床表现、实验室发现以及 SOFA 和 qSOFA 与死亡率的相关性。
这是一项回顾性研究，纳入了 393 例至少有一次阳性血培养且在入院后 48 小时内最多采集一次细菌的患者。收集了患者入院后前 24 小时的临床特征和实验室结果。计算了 SOFA 和 qSOFA 评分，并评估了其在该环境中的有效性。
在 393 例患有细菌性 CABSI 的患者中，约 80%（307/393）的患者在入组研究医院时存在一个或多个器官功能障碍，最常见的是凝血功能障碍（57.1%或 226/393）。SOFA 对最初收入重症监护病房的患者的死亡率预测效果良好（AUC 0.858，95%CI 0.793-0.922），但对收入内科病房的患者预测效果不佳（AUC 0.667，95%CI 0.577-0.758）。相比之下，qSOFA 在这两种情况下的预测有效性都较差（AUC 0.692，95%CI 0.605-0.780 和 AUC 0.527，95%CI 0.424-0.630）。总的病死率为 28%。HIV 感染（HR=3.145，p=0.001）、中性粒细胞减少症（HR=2.442，p=0.002）、SOFA 评分增加 1 分（HR=1.19，p<0.001）和肠杆菌科感染（HR=1.722，p=0.037）是院内死亡的独立危险因素。
越南 CABSI 患者中器官功能障碍很常见，与高病死率相关。SOFA 和 qSOFA 均需在此环境中进一步验证。
