Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study

摘要

Background Sepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia. Methods We prospectively recruited hospitalized adults within 24?h of admission with community-acquired infection at nine public hospitals in Indonesia ( n =?3), Thailand ( n =?3), and Vietnam ( n =?3). In patients with organ dysfunction (total SOFA score ≥?2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥?3 for an individual organ system. Results From December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24?h of admission was low: broad-spectrum antibiotics in 76% (344/454), ≥?1500?mL fluid in 50% of patients with hypotension or lactate ≥?4?mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, p