Predictive validity of the quick Sequential Organ Failure Assessment (qSOFA) score for the mortality in patients with sepsis in Vietnamese intensive care units

Predictive validity of the sequential organ failure assessment score for mortality in patients with acute respiratory distress syndrome in Vietnam

Evaluating the prognosis of ARDS patients using grading systems can enhance treatment decisions. This retrospective observational study evaluated the predictive accuracy of the SOFA score, APACHE II score, SpO2/FiO2 ratio, and PaO2/FiO2 ratio for mortality in ARDS patients in Vietnam. The study included 335 adult ARDS patients admitted to a central hospital from August 2015 to August 2023. Among them, 66.9% were male, the median age was 55 years, and 61.5% died in the hospital. The SOFA (AUROC: 0.651) and APACHE II scores (AUROC: 0.693) showed poor discriminatory ability for hospital mortality. The SpO2/FiO2 (AUROC: 0.595) and PaO2/FiO2 ratios (AUROC: 0.595) also displayed poor discriminatory ability. In multivariable analyses, after adjusting for the same set of confounding variables, the APACHE II score (adjusted OR: 1.152), SpO2/FiO2 ratio (adjusted OR: 0.985), and PaO2/FiO2 ratio (adjusted OR: 0.989) were independently associated with hospital mortality. Although the SOFA score (adjusted OR: 1.132) indicated a potential association with hospital mortality, it did not reach statistical significance (p = 0.081). However, a SOFA score of ≥ 10 emerged as an independent predictor (adjusted OR: 3.398) of hospital mortality. These findings emphasize the need for further studies to develop more accurate scoring systems for predicting outcomes in ARDS patients.

Identification of Risk of Early Decompensation and Predictors of ICU Admission in Patients Triggering Code Sepsis

Introduction "Code Sepsis" is a protocol, auto-initiated as a system-based trigger in our community-based teaching center. It is designed to be activated in patients with two or more systemic inflammatory response syndrome (SIRS) criteria and organ dysfunction. The purpose is to identify sepsis early and treat it according to the Surviving Sepsis guidelines. If clinically indicated, patients are rapidly evaluated and treated with antibiotics and fluid boluses. Despite proactive measures to improve patient outcomes, clinical deterioration can still occur, which may necessitate ICU admission, vasopressor initiation, and even increased morbidity and mortality. In this study, we aimed to compare patients who triggered a code sepsis requiring ICU admission at a teaching hospital with those who did not require ICU admission, identifying risk factors for early decompensation. Methods We conducted a retrospective study to gather data on all patients admitted to the hospital between September 1, 2022, and December 31, 2022, who triggered code sepsis. Subjects were identified based on whether they triggered code sepsis, and demographic details, admission details, laboratory values, and code sepsis notes were collected using a Redcap questionnaire. The data was reviewed and evaluated using STATA software (Stata Corp., College Station, TX, USA), and means were calculated and compared between the two outcome cohorts. Multivariate logistic regression analysis was performed to determine adjusted odds ratios (OR). Results For patients who triggered code sepsis, the mean age (63.94 vs. 63.71, p=0.963) and mean length of stay (11.94 vs. 10.03 days, p=0.422) were comparable between those who required ICU admission and those who did not. However, there were significant differences in other factors. The mean initial lactate (2.22 vs. 1.40, p=0.017), initial alanine aminotransferase (ALT) level (74.52 vs. 37.11, p<0.05), and aspartate aminotransferase (AST) levels (149.84 vs. 61.03, p=0.005) were significantly higher in patients who required ICU level care. At the time of code sepsis, patients who needed a 30 cc/kg fluid bolus (OR=12.8, p<0.01), or had hypotension in the first hour after the event (OR=7.94, p<0.01) had a higher chance of requiring ICU admission. Patients meeting quick sequential organ failure assessment (qSOFA) criteria (OR= 4.4 and 5, p<0.01) and requiring escalation of antibiotics (OR=19.33, p<0.01) at the time of code sepsis were also more likely to require ICU. White cell count, glucose level, serum creatinine, and troponins at admission were comparable in both groups. There was no statistically significant difference in the distribution of co-morbidities such as type 2 diabetes, hypertension, cardiovascular, or kidney disease among the patients who went to the ICU versus those who did not. Conclusion Code sepsis, triggered by the system or physician, identifies the presence of SIRS and organ dysfunction, thus enabling healthcare providers to intervene and manage sepsis or septic shock earlier. Higher lactate levels, the presence of transaminitis during the initial trigger event, and positive qSOFA criteria indicate a worse prognosis. This may require escalation of care to the ICU, closer monitoring, and possible use of vasopressor support. Early identification of such individuals can lead to better management of their condition.

Predictive validity of interleukin 6 (IL-6) for the mortality in critically ill COVID-19 patients with the B.1.617.2 (Delta) variant in Vietnam: a single-centre, cross-sectional study

OBJECTIVES

To investigate the serum IL-6 levels and their rate of change in predicting the mortality of critically ill patients with COVID-19 in Vietnam.

DESIGN

A single-centre, cross-sectional study.

SETTING

An Intensive Care Centre for the Treatment of Critically Ill Patients with COVID-19 in Ho Chi Minh City, Vietnam.

PARTICIPANTS

We included patients aged 18 years or older who were critically ill with COVID-19 and presented to the study centre from 30 July 2021 to 15 October 2021. We excluded patients who did not have serum IL-6 measurements between admission and the end of the first day.

PRIMARY OUTCOME MEASURES

The primary outcome was hospital all-cause mortality.

RESULTS

Of 90 patients, 41.1% were men, the median age was 60.5 years (Q1-Q3: 52.0-71.0), and 76.7% of patients died in the hospital. Elevated IL-6 levels were observed on admission (41.79 pg/mL; Q1-Q3: 20.68-106.27) and on the third day after admission (72.00 pg/mL; Q1-Q3: 26.98-186.50), along with a significant rate of change in IL-6 during that period (839.5%; SD: 2753.2). While admission IL-6 level (areas under the receiver operator characteristic curve (AUROC): 0.610 (95% CI: 0.459 to 0.761); cut-off value ≥15.8 pg/mL) and rate of change in IL-6 on the third day of admission (AUROC: 0.586 (95% CI: 0.420 to 0.751); cut-off value ≥-58.7%) demonstrated poor discriminatory ability in predicting hospital mortality, the third day IL-6 rate of change from admission ≥-58.7% (adjusted OR: 12.812; 95% CI: 2.104 to 78.005) emerged as an independent predictor of hospital mortality.

CONCLUSIONS

This study focused on a highly selected cohort of critically ill COVID-19 patients with a high IL-6 level and mortality rate. Despite the poor discriminatory value of admission IL-6 levels, the rate of change in IL-6 proved valuable in predicting mortality. To identify critically ill COVID-19 patients with the highest risk for mortality, monitoring the serial serum IL-6 measurements and observing the rate of change in serum IL-6 levels over time are needed.

Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Sequential Organ Failure Assessment (SOFA) Score for predicting mortality in patients with sepsis in Vietnamese intensive care units: a multicentre, cross-sectional study

OBJECTIVES

To compare the accuracy of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) Scores in predicting mortality among intensive care unit (ICU) patients with sepsis in a low-income and middle-income country.

DESIGN

A multicentre, cross-sectional study.

SETTING

A total of 15 adult ICUs throughout Vietnam.

PARTICIPANTS

We included all patients aged ≥18 years who were admitted to ICUs for sepsis and who were still in ICUs from 00:00 to 23:59 of the specified study days (ie, 9 January, 3 April, 3 July and 9 October of the year 2019).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was hospital all-cause mortality (hospital mortality). We also defined the secondary outcome as all-cause deaths in the ICU (ICU mortality).

RESULTS

Of 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs. SOFA Score (areas under the receiver operating characteristic curve (AUROC): 0.688 (95% CI 0.618 to 0.758); cut-off value≥7.5; P_AUROC<0.001) and APACHE II Score (AUROC: 0.689 (95% CI 0.622 to 0.756); cut-off value ≥20.5; P_AUROC<0.001) both had a poor discriminatory ability for predicting hospital mortality. However, the discriminatory ability for predicting ICU mortality of SOFA (AUROC: 0.713 (95% CI 0.643 to 0.783); cut-off value≥9.5; P_AUROC<0.001) was fair and was better than that of APACHE II Score (AUROC: 0.672 (95% CI 0.603 to 0.742); cut-off value≥18.5; P_AUROC<0.001). A SOFA Score≥8 (adjusted OR (AOR): 2.717; 95% CI 1.371 to 5.382) and an APACHE II Score≥21 (AOR: 2.668; 95% CI 1.338 to 5.321) were independently associated with an increased risk of hospital mortality. Additionally, a SOFA Score≥10 (AOR: 2.194; 95% CI 1.017 to 4.735) was an independent predictor of ICU mortality, in contrast to an APACHE II Score≥19, for which this role did not.

CONCLUSIONS

In this study, SOFA and APACHE II Scores were worthwhile in predicting mortality among ICU patients with sepsis. However, due to better discrimination for predicting ICU mortality, the SOFA Score was preferable to the APACHE II Score in predicting mortality.Clinical trials registry - India: CTRI/2019/01/016898.