College of Medicine, University of Malawi, Blantyre, Malawi.
Department of Internal Medicine, Nyköping Hospital, Nyköping, Sweden.
Am J Trop Med Hyg. 2020 Apr;102(4):896-901. doi: 10.4269/ajtmh.19-0320.
There are an estimated 19.4 million sepsis cases every year, many of them in low-income countries. The newly adopted definition of sepsis uses Sequential Organ Failure Assessment Score (SOFA), a score which is not feasible in many low-resource settings. A simpler quick-SOFA (qSOFA) based solely on vital signs score has been devised for identification of suspected sepsis. This study aimed to determine in-hospital prevalence and outcomes of sepsis, as defined as suspected infection and a qSOFA score of 2 or more, in two hospitals in Malawi. The secondary aim was to evaluate qSOFA as a predictor of mortality. A cross-sectional study of adult in-patients in two hospitals in Malawi was conducted using prospectively collected single-day point-prevalence data and in-hospital follow-up. Of 1,135 participants, 81 (7.1%) had sepsis. Septic patients had a higher hospital mortality rate (17.5%) than non-septic infected patients (9.0%, = 0.027, odds ratio 2.1 [1.1-4.3]), although the difference was not statistically significant after adjustment for baseline characteristics. For in-hospital mortality among patients with suspected infection, qSOFA ≥ 2 had a sensitivity of 31.8%, specificity of 82.1%, a positive predictive value of 17.5%, and a negative predictive value of 91.0%. In conclusion, sepsis is common and is associated with a high risk of death in admitted patients in hospitals in Malawi. In low-resource settings, qSOFA score that uses commonly available vital signs data may be a tool that could be used for identifying patients at risk-both for those with and without a suspected infection.
每年估计有 1940 万例败血症病例，其中许多发生在低收入国家。新采用的败血症定义使用序贯器官衰竭评估评分（SOFA），但在许多资源匮乏的环境中，该评分并不可行。因此，设计了一种更简单的基于生命体征的快速 SOFA（qSOFA）评分，用于识别疑似败血症。本研究旨在确定马拉维两家医院中，根据疑似感染和 qSOFA 评分≥2 定义的败血症的院内患病率和结局。次要目标是评估 qSOFA 作为死亡率的预测指标。这是一项在马拉维两家医院进行的成年住院患者的横断面研究，使用前瞻性收集的单日点患病率数据和院内随访。在 1135 名参与者中，有 81 人（7.1%）患有败血症。败血症患者的医院死亡率（17.5%）高于非感染性败血症患者（9.0%， = 0.027，优势比 2.1[1.1-4.3]），尽管在调整基线特征后，差异无统计学意义。对于疑似感染患者的院内死亡率，qSOFA≥2 的灵敏度为 31.8%，特异性为 82.1%，阳性预测值为 17.5%，阴性预测值为 91.0%。总之，败血症在马拉维医院的住院患者中很常见，并且与死亡风险增加相关。在资源匮乏的环境中，使用常用生命体征数据的 qSOFA 评分可能是一种可用于识别高危患者的工具，包括疑似感染和无感染的患者。
