Impact of “quick Sequential Organ Failure Assessment” (qSOFA) at admission to the Intensive Care Unit on hospital outcome for critically ill patient at Kigali University Teaching Hospital

Abstract

Background: Sepsis is a significant cause of morbidity and mortality worldwide with an increasing incidence. The qSOFA is used as a screening tool for sepsis in developed countries. This study aims to determine the impact of qSOFA in the prediction of outcome in adult patients admitted to the ICU of Kigali University Teaching Hospital (CHUK), with or without a suspected infection. Methodology: Data of adult patients admitted in ICU of CHUK were retrospectively and prospectively collected from May 2019 to December 2020. I entered data in Epi-Info version 3 then defined high versus low-risk groups according to their qSOFA scores. I calculated raw mortality and prognostic performance values for both risk groups and analyzed AUROC as primary outcome and average ICU length of stay and post- ICU discharge mortality rate as secondary outcome. Results: The study consisted of 148 participants. One hundred and forty one were enrolled for analysis with 40 (28.4%) in the high-risk group (qSOFA score ≥2) and 101 (71.6%) in the low-risk group. The median age was 33 (IQR: 24-41.5) for the high-risk group, which was significantly smaller than the median age of 40 (IQR: 31-59) for the low-risk group. ICU and post-ICU discharge mortality rate in the high-risk vs. low-risk group was 20% and 0% vs. 19.6% and 3.5% respectively. The prognostic performance value of the qSOFA score (with a cutoff of 2) in predicting ICU mortality consisted of 29% sensitivity, 73% specificity, 21% positive predictive value, and 80% negative predictive value. The area under the receiver operating characteristic curve was 0.555 (95% CI -.528-0.589). The median ICU length of stay was 6 days (IQR 2-10) and 5 days (IQR 3-11) for the high-risk vs. low-risk group with an absolute difference of 2.89 (95% CI -1.83 to 7.62, p-value 0.118). Conclusion: Following the index study it was found that the qSOFA score was a poor predictor of ICU outcomes in this setting.