• Adam R Aluisio, Stephanie Garbern, Tess Wiskel, Zeta A Mutabazi, Olivier Umuhire, Chin Chin Ch'ng, Kristina E Rudd, D'Arc Nyinawankusi Jeanne J Service d'Aide Médicale Urgente, Kigali, Rwanda., Jean Claude Byiringiro, and Adam C Levine.
• Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA. Electronic address: adam.aluisio@gmail.com.
• Am J Emerg Med. 2018 Nov 1; 36 (11): 2010-2019.

ObjectiveTo evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting.MethodsThis retrospective cohort study was carried out at a tertiary-care hospital, in Kigali, Rwanda and included patients ≥15years, presenting for ED care during 2013 with an infectious disease (ID). ED and overall hospital mortality were evaluated using multivariable regression, with qSOFA scores as the primary predictor (reference: qSOFA=0), to yield adjusted relative risks (aRR) with 95% confidence intervals (CI). Analyses were performed for the overall population and stratified by HIV status.ResultsAmong 15,748 cases, 760 met inclusion (HIV infected 197). The most common diagnoses were malaria and intra-abdominal infections. Prevalence of ED and hospital mortality were 12.5% and 25.4% respectively. In the overall population, ED mortality aRR was 4.8 (95% CI 1.9-12.0) for qSOFA scores equal to 1 and 7.8 (95% CI 3.1-19.7) for qSOFA scores ≥2. The aRR for hospital mortality in the overall cohort was 2.6 (95% 1.6-4.1) for qSOFA scores equal to 1 and 3.8 (95% 2.4-6.0) for qSOFA scores ≥2. For HIV infected cases, although proportional mortality increased with greater qSOFA score, statistically significant risk differences were not identified.ConclusionThe qSOFA score provided risk stratification for both ED and hospital mortality outcomes in the setting studied, indicating utility in sepsis care in SSA, however, further prospective study in high-burden HIV populations is needed.Copyright © 2018 Elsevier Inc. All rights reserved.

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