Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings
Authors: Li Andrew , Ling Lowell , Qin Hanyu , Arabi Yaseen M. , Myatra Sheila Nainan , Egi Moritoki , Kim Je Hyeong , Nor Mohd Basri Mat , Son Do Ngoc , Fang Wen-Feng , Wahyuprajitno Bambang , Hashmi Madiha , Faruq Mohammad Omar , Patjanasoontorn Boonsong , Al Bahrani Maher Jaffer , Shrestha Babu Raja , Shrestha Ujma , Nafees Khalid Mahmood Khan , Sann Kyi Kyi , Palo Jose Emmanuel M. , Mendsaikhan Naranpurev , Konkayev Aidos , Detleuxay Khamsay , Chan Yiong Huak , Du Bin , Divatia Jigeeshu Vasishtha , Koh Younsuck , Phua Jason ,   the MOSAICS II Study Group, Mallick Uzzal Kumar , Islam Motiul , Hamid Tarequl , Islam A. K. M. Shirazul , Halim Rabiul , Khan Md Arifur Rahman , Asaduzzaman Mohammad , Karim Md Rezaul , Sarwar Nahim , Milon Shamsul Hoque , Mahmud Rashed , Hirok A. K. M. Sirajul Islam , Haque Ashraful , Sultana Amina , Shajal Mir Atiqur Rahman , Andalib Farha , Hasan Rashedul , Nafees Khalid Mahmood Khan , Dhansukhlal Shah Sudhirchandra , Li Ning , Liu Xiaowei , Yang Haiwei , Hou Ming , Li Ying , Zhang Jian , Huang Lifeng , Li Wenxiong , Duan Meili , Liu Taotao , He Wei , Ning Fangyu , Wang Xiaozhi , Zhou Xiaoyan , Yu Sun , Xiang Xiang , Pan Liang , Zhou Feihu , Wang Yaoli , Zhou Jian , Wang Tao , Yang Xuefei , Ma Yu , Song Xuan , Wu Haiying , Qian Chuanyun , Zhou Lixin , Xu Zuohang , Zhang Kun , Hu Zhenjie , Lin Xingsheng , Shi Songjing , Zhang Xiaoguang , Yu Rongguo , Zhang Liqin , Yuan Yuan , Zhou Huiru , Wang Xiandong , Wang Zhonghua , Qin Tiehe , Shi Xianqing , Li Rui , He Zhenyang , Zuo Xiangrong , Cao Quan , He Tao , Sui Yuanda , Wu Tiejun , Xu Ying , Gu Qin , Shuai Weizheng , Qin Hanyu , Du Bin , Qiao Hong , Li Shuangling , Dong Guiying , Zhao Xiujuan , Zhu Fengxue , Wang Junshi , Huang Lei , Wang Tianchang , Wang Hao , Ma Siqing , Yang Zhengping , Gao Yuan , Tan Ruoming , Xie Yun , Wang Ruilan , Jia Jia , Zang Bin , Wang Jun , Lin Ling , Wu Yuwen , Wu Yunfu , Ma Penglin , Li Yanfang , Yu Li , Guo Rui , Zhang Jiuzhi , Wan Xianyao , Shen Feng , Shi Qindong , Xu Jun , Fang Qiang , Liu Shaohua , Sun Tongwen , Zeng Mian , Pan Weiyun , Liu Zhongmin , Lin Qingling , Wang Nan , Pang Jing , Xiong Bin , Wen Deliang , Kang Fuxin , Chang Liuhui , Sun Yun , Zhang Jingxiao , Yin Yongjie , Qing Liu , Sun Jiajun , Li Nahui , Wang Yongqiang , Shou Songtao , Chai Yanfen , Xu Lei , Yang Xiaobo , Liao Xuelian , Kang Xian , Zhao Shuangping , Huang Liquan , Zhang Run , Sun Renhua , Shen Chao , He Yan , Chow Fu Loi , Tang Michele , Lam Philip , Cham Esther , Tang Kin Bong , Ling Lowell , Dharmangadan Manimala , Ng Pauline Yeung , Ling Kin Ho , Lau Vincent , Sahu Samir , Chatterjee Sharmila , Basu Sushmita , Mohamed Zubair Umer , Sirga Sudeep , Kasireddy Siddhartha Reddy , Aleem M. A. , Kuragayala Swarna Deepak , Haranath Sai Praveen , Ramakrishnan Nagarajan , Amin Pravin , Mascarenhas Joanne , Dash Radhika , Kola Venkat Raman , Vaidyanathan R. , Agarwal Siddharth , Bhattacharya Pradip K. , Jeswani Deepak , Gautam Parshotum Lal , Ansari Abdul Samad , Nangia Vivek , Sircar Mrinal , Balasubramani V. M. , Maneendra S. , Mishra Sanghamitra , Kumar Anjeev , Chawla Rajesh , Sequeira Trevor Francis , Shrivastava Om Prakash , Sreevalsan T. V. , Shetty Rajesh Mohan , Thimmappa Manjunath , Harish M. M. , Mehta Yatin , Saxena Divya , Mishra Vipul , Kumar Rishi , Jha Simnt Kumar , Sakhavalkar Prashant , Diwane Dnyaneshwar , Dixit Subhal , Kalaiselvan  , Pattnaik Manoranjan , Singh Lalit , Khan Fareed , Shah Mehul , Prasanna  , Joshi Ziokov , Myatra Sheila Ninan , Gorade Manoj , Jagiasi Bharat G. , Hartalkar Amol , Prusty B. Saroj Kumar , Yogesh  , Winata Ade , Maulydia  , Wijaya Surya Oto , Prihartini Hermin , Hutajulu Shinta V. R. , Manalu Rudy , Sumartono Christrijogo , Albandjar Chrisma Adryana , Pitaloka Ira , Kusumawati Dewi , Arifin  , Jufan Akhmad Yun , Semedi Bambang Pujo , Silalahi Vanessy Theodora , Yudianto  , Pradian Erwin , Hanafie Achsanuddin , Fitriati Mariza , Maskoen Tinni Trihartini , Abadi Satriawan , Wisudarti Calcarina Fitriani Retno , Arifin Johan , Sudjud Reza Widyanto , Airlangga Prananda Surya , Rupi’i  , Wiryana I. Made , Achmadi Anang , Harly Patra Rijalul , Kusuma Edward , Wibowo Primartanto , HY Ade Veronica , Mandang Jeni Sarah , Meriwijanti  , Aryabiantara I. Wayan , Muchtar Faisal , Isa Fachrul Jamal , Aditianingsiih Dita , Simamora Nicolaas Parningotan , Hasyim Moch. , Manuaba I. Gusti Putu , Anggraeni Novita , Sanoesi Rudy Ariyanto , Munandar Arief , Siahaan Duma Saurma , Rachmawati Sri , Susianto Oky , Kahar Liliriawati Ananta , Zulkifli  , Laihad Mordekhai Leopold , Takaaki Nakada , Hara Yoshitaka , Nishida Osamu , Uehara Kenji , Takatori Makoto , Ohshimo Shinichiro , Kikutani Kazuya , Shime Nobuaki , Nunomiya Shin , Katayama Shinshu , Atari Bengo , Ito Takashi , Kakihana Yasuyuki , Takimoto Kohei , Yanai Machi , Egi Moritoki , Yatabe Tomoaki , Kishiara Yuki , Higashijima Ushio , Sekino Motohiro , Atagi Kazuaki , Ogura Hiroshi , Matsubara Tsunehiro , Kamio Tadashi , Fujitani Shigeki , Yoshida Toru , Aoyagi Yukari , Uchino Shigehiko , Hasegawa Masatsugu , Oto Jun , Yamaguchi Naoki , Enomoto Yuki , Nakane Masaki , Amirova G. S. , Daribaev Murat , Evgenievich Markov Viktor , Vorobiev A. A. , Andrushenko A. V. , Torpakbaeva Aliya , Konkayeva M. E. , Galkin A. V. , Ostanin P. A. , Detleuxay Khamsay , Samat Noryani Mohd , Tan Ismail , Ismail Nahla Irtiza , Lim Chew Har , Ismail Wan Nasrudin Wan , Sulaiman Siti Rohayah , Alias Anita , Wen Joanne Tiong Jia , Rahim Azmin Huda Abdul , Zainudin Asmah , Adib Nik Azman Nik , Abdullah Zihni , Hafizah  , Mazlan Mohd Zulfakar , Nor Mohd Basri Mat , Munkhasiakhan  , Naranpurev  , Tun Cho Myint , Maw Thinzar , Cho Cho , Sein Han , Win Myo Malar , Hnin Lwin Lwin , Lwin Cho Cho , Mon Aye Su , Thein Yi Sandar , Le Le Yi Khin , Naing Myo Min , May Nu Nu , Naing Lun , Aung Khin Saw Yu , Lin Moe Thu , Kyi Aung , Tun Kyaw Min Min , Khin Suu New , Yi Khin Pyone , Waan Khin May , Thidar Moe , Sann Kyi Kyi , Naing Mu Mu , Mar Win Win , Lin Naing Naing , Rajbanshi Lalit , Limbu Trishant , Shrestha Baburaja , Shrestha Ujma , Shrestha Ashish , Pradhan Rosi , Shrestha Ravi Ram , Acharya Sulav , Shrestha Pramesh Sunder , Karki Puja Thapa , Awladthani Moosa , Paul Jacob , Al Badi Nadia , Al Kharusi Adil , Al Kharousi Khalil , Kantor Sandeep , John Yohannan , Al Mandhari Said , Jacob Geetha , Esmat Amr Muhammad , Shetty B. M. J. , Mostafa Ahmed , Rashid Naveed Haroon , Sohaib Muhammad , Joseph Sonia , Zafar Safia , Farooq Ahmed , Ashraf Muhammad Sheharyar , Hussain Tanveer , Hayat Muhammad , Rehman Ataur , Ali Syed Muneeb , Rehman Saad ur , Kumar Ashok , Hernandez Aaron , Aperocho Crystal , Resurreccion Raymundo , Noblezada-Uy Debbie , Palo Jose Emmanuel , Visperas Julie , Asiri Amer , Beshabshi Ali , Al-Hameed Fahad , Al Orabi Ohoud , Arabi Yaseen , Al Qasim Eman , Iqbal Masood , Aisa Tharwat , Al Shahrani Mohammed Saeed , Asonto Laila , Kharaba Ayman , al Mutairi Abdullah , Al Ghamdi Khaild , Hefni Lama , Al Qurashi Ahmad , Al Makhlafi Galeb , Gokhale Roshni Sadashiv , Lim Noelle , Pawar Manjit , Kumaresh Venkatesan , Hock Naville Chia Chi , Keat Tan Chee , An Tan Rou , De Souza Jared , Li Andrew , Seng Yip Hwee , Phua Jason , YH Addy Tan , Kiang Melvin Tay Chee , Yi Ng Shin , Kian Ho Vui , Sharma Kiran , Lew Sennen , Min Lee Rui , Kim Do Wan , Shin Yoon Mi , Lee Song-I. , Kim Kyung Chan , Kang Yun-Seong , Lee Soo Hwan , Kim Ho Cheol , Sim Yun Su , Park Sunghoon , Park Tai Sun , Lee Hongyeul , Chang Youjin , Lee Heung Bum , Kim Je Hyeong , Lee Young Seok , Kwack Won Gun , Kim In Byung , Park Tae Yun , Cho Young Jae , Lee Sang-Min , Jeon Kyeongman , Lee Jongmin , Kim Shin Young , Huh Jin-Won , Ahn Jong Joon , Cho Jae Hwa , Lee Won-Yeon , Lin Chin-Kuo , Chu Chang-Ke , Wu Jiun-Ting , Lin Chiung-Yu , Chen Yu-Mu , Huang Kuo-Tung , Hu Han-Chung , Cia Cong-tat , Chien Jung-Yien , Huang Chun-Te , Fu Pin-Kuei , Srisawas Nattachai , Kongwibulwut Manasnun , Chittawatanarat Kaweesak , Daewtrakulchai Worapot , Phunmanee Anakapong , Panitchote Anupol , Patjanasoontorn Boonsong , Sawawiboon Chaiwut , Trung Lê Minh , Sơn Đỗ Ngọc , Hà B. S. Bùi Nhật , Phước Dương Thiện , Đại Huỳnh Quang , Hùng Nguyễn Tấn , Thúy Lê Thị Phương , Hải Hoàng Bùi , Quốc Hoàng Trọng Ái , Linh Trần Hoài , Yến Vũ Hải , Giang Phạm Trà , Ngà Nguyễn Thị , Tuân Nguyễn Đăng ,   for the Asian Critical Care Clinical Trials Group
Published: January 2024

Abstract
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.

Graphical Abstract