Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
Crit Care. 2024 Jan 23;28(1):30. doi: 10.1186/s13054-024-04804-7.
There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions.
This was a secondary analysis of the MOSAICS II study, an international prospective observational study on sepsis epidemiology in Asian ICUs. Associations between qSOFA at ICU admission and mortality were separately assessed in LLMIC, UMIC and HIC countries/regions. Modified Poisson regression was used to determine the adjusted relative risk (RR) of qSOFA score on mortality at 28 days with adjustments for confounders identified in the MOSAICS II study.
Among the MOSAICS II study cohort of 4980 patients, 4826 patients from 343 ICUs and 22 countries were included in this secondary analysis. Higher qSOFA was associated with increasing 28-day mortality, but this was only observed in LLMIC (p < 0.001) and UMIC (p < 0.001) and not HIC (p = 0.220) countries/regions. Similarly, higher 90-day mortality was associated with increased qSOFA in LLMIC (p < 0.001) and UMIC (p < 0.001) only. In contrast, higher 3-day mortality with increasing qSOFA score was observed across all income countries/regions (p < 0.001). Multivariate analysis showed that qSOFA remained associated with 28-day mortality (adjusted RR 1.09 (1.00-1.18), p = 0.038) even after adjustments for covariates including APACHE II, SOFA, income country/region and administration of antibiotics within 3 h.
qSOFA was independently associated with 28-day mortality in ICU patients admitted for sepsis. In LLMIC and UMIC countries/regions, qSOFA was associated with early to late mortality but only early mortality in HIC countries/regions.
快速序贯器官衰竭评估（qSOFA）与 ICU 患者脓毒症死亡率之间的关联存在相互矛盾的证据。本研究的主要目的是确定 qSOFA 与 ICU 患者因脓毒症入院的 28 天死亡率之间的关系。在低收入和中低收入（LMIC）、中高收入（UMIC）和高收入（HIC）国家/地区，评估 qSOFA 与早期（3 天）、中期（28 天）、晚期（90 天）死亡率的关系。
这是 MOSAICS II 研究的二次分析，这是一项关于亚洲 ICU 中脓毒症流行病学的国际前瞻性观察研究。在 LLMIC、UMIC 和 HIC 国家/地区，分别评估 ICU 入院时 qSOFA 与死亡率之间的关系。使用校正后的 Poisson 回归来确定 qSOFA 评分对 28 天死亡率的调整相对风险（RR），并对 MOSAICS II 研究中确定的混杂因素进行调整。
在 MOSAICS II 研究队列的 4980 名患者中，共有来自 343 个 ICU 和 22 个国家的 4826 名患者纳入本二次分析。qSOFA 评分越高，28 天死亡率越高，但仅在 LLMIC（p<0.001）和 UMIC（p<0.001）国家/地区观察到这种情况，而在 HIC 国家/地区（p=0.220）则未观察到。同样，qSOFA 评分升高与 LLMIC（p<0.001）和 UMIC（p<0.001）的 90 天死亡率升高相关。相反，qSOFA 评分升高与所有收入国家/地区的 3 天死亡率升高相关（p<0.001）。多变量分析显示，即使在调整 APACHE II、SOFA、收入国家/地区和 3 小时内使用抗生素等混杂因素后，qSOFA 仍与 28 天死亡率相关（调整后的 RR 1.09（1.00-1.18），p=0.038）。
qSOFA 与 ICU 患者因脓毒症入院的 28 天死亡率独立相关。在 LLMIC 和 UMIC 国家/地区，qSOFA 与早期至晚期死亡率相关，但仅与 HIC 国家/地区的早期死亡率相关。
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