Predictive Validity of the qSOFA Score for Sepsis in Adults with Community-Onset Staphylococcal Infection in Thailand

The quick sequential organ failure assessment (qSOFA) score has had limited validation in lower resource settings and was developed using data from high-income countries. We sought to evaluate the predictive validity of the qSOFA score for sepsis within a low- and middle-income country (LMIC) population with culture-proven staphylococcal infection. This was a secondary analysis of a prospective multicenter cohort in Thailand with culture-positive infection due to Staphylococcus aureus or S. argenteus within 24 h of admission and positive (≥2/4) systemic inflammatory response syndrome (SIRS) criteria. Primary exposure was maximum qSOFA score within 48 h of culture collection and primary outcome was mortality at 28 days. Baseline risk of mortality was determined using a multivariable logistic regression model with age, gender, and co-morbidities significantly associated with the outcome. Predictive validity was assessed by discrimination of mortality using area under the receiver operating characteristic (AUROC) curve compared to a model using baseline risk factors alone. Of 253 patients (mean age 54 years (SD 16)) included in the analysis, 23 (9.1%) died by 28 days after enrollment. Of those who died, 0 (0%) had a qSOFA score of 0, 8 (35%) had a score of 1, and 15 (65%) had a score ≥2. The AUROC of qSOFA plus baseline risk was significantly greater than for the baseline risk model alone (AUROCqSOFA = 0.80 (95% CI, 0.70–0.89), AUROCbaseline = 0.62 (95% CI, 0.49–0.75); p < 0.001). Among adults admitted to four Thai hospitals with community-onset coagulase-positive staphylococcal infection and SIRS, the qSOFA score had good predictive validity for sepsis.

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The Performance of Sepsis-3 Criteria to Predict Mortality among patients with hematologic malignancy and post-transplant who have Suspected Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab529 ◽

2021 ◽

Author(s):

Oryan Henig ◽

Rosemary K B Putler ◽

Owen Albin ◽

Twisha S Patel ◽

Daniel Kaul ◽

...

Keyword(s):

Hospital Mortality ◽

Predictive Validity ◽

Risk Model ◽

Hematologic Malignancy ◽

Positive Likelihood Ratio ◽

Clinical Score ◽

Baseline Risk ◽

Immunocompromised Patients ◽

Suspected Infection ◽

Dichotomous Variables

Abstract Background Sepsis is a leading cause of death, particularly in immunocompromised people. The revised definition of sepsis (Sepsis-3) uses Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) to identify patients with sepsis. The aim of this study was to evaluate the performance of SOFA, qSOFA and SIRS (systemic inflammatory response syndrome) in immunocompromised patients. Methods Adult immunocompromised patients admitted to Michigan Medicine between 2012-2018 with suspected infection were included based on criteria adopted from the Sepsis-3 study. Each clinical score (SOFA≥2, qSOFA≥2, SIRS≥2) was added to the baseline risk model as an ordinal as well as dichotomous variables and AUROC values were calculated. In addition, breakpoints of SOFA between 2-10 were assessed to identify the breakpoints with the highest sensitivity and specificity for hospital mortality. The analysis was stratified for intensive care unit (ICU) status. Results Of 2822 immunocompromised patients with a mean age of 56.8±15.6, 213 (7.5%) died during hospitalization. When added to the baseline risk model, SOFA score had the greatest predictive validity for hospital mortality [AUROC=0.802 (95%CI: 0.771-0.832)], followed by qSOFA (AUROC=0.783 (0.754-0.812) and SIRS (AUROC=0.741 (0.708-0.774]). Among SOFA breakpoints that were evaluated, SOFA≥6 had the greatest predictive validity and moderate positive likelihood ratio (2.75) for hospital mortality. Conclusion The predictive validity for hospital mortality of qSOFA was similar among immunocompromised patients to that reported in the Sepsis-3 study. The sensitivity of qSOFA≥2 for hospital mortality was low. SOFA≥6 might be an effective tool to identify immunocompromised patients with suspected infection at high risk for clinical deterioration.

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Impaired Ventilation Is Not Independently Associated With 28-day Mortality in COVID-19 ARDS

10.21203/rs.3.rs-150970/v1 ◽

2021 ◽

Author(s):

Luis Morales-Quinteros ◽

Ary Serpa Neto ◽

Antonio Artigas ◽

Lluis Blanch ◽

Michela Botta ◽

...

Keyword(s):

The Netherlands ◽

Dead Space ◽

Risk Model ◽

Direct Method ◽

Secondary Analysis ◽

Case Series ◽

Baseline Risk ◽

Prognostic Information ◽

Increased Risk ◽

End Tidal

Abstract Background: Surrogates for impaired ventilation such as estimated dead-space fractions and the ventilatory ratio have been shown to be independently associated with an increased risk of mortality in the acute respiratory distress syndrome and small case series of COVID-19 related ARDS. Methods: Secondary analysis from the PRoVENT-COVID study. The PRoVENT-COVID is a national, multicentre, retrospective observational study done at 22 intensive care units in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The aim was to quantify the dynamics and determine the prognostic value of surrogate markers of impaired ventilation patients with COVID-19 related ARDS. Results: 927 consecutive patients admitted with COVID-19 related ARDS were included in this study. Surrogates of impaired ventilation such as the estimated dead space fraction (by Harris-Benedict and direct method) and ventilatory ratio were significantly higher in non-survivors than survivors at baseline and during the following days of mechanical ventilation (p <0.001). The end-tidal-to-arterial PCO2 ratio was lower in non-survivors than in survivors (p<0.001). As ARDS severity increased, mortality increased with successive tertiles of dead space fraction by Harris-Benedict and by direct estimation, and for the VR. The same trend was observed with decreased levels in the tertiles for the end-tidal-to-arterial PCO2 ratio. After adjustment for a base risk model that included chronic comorbidities and ventilation- and oxygenation-parameters, none of the surrogates of impaired ventilation measured at the start of ventilation or the following days were significantly associated with 28-day mortality.Conclusions: There is significant impairment of ventilation in the early course of COVID-19 related ARDS but quantification of this impairment does not add prognostic information when added to a baseline risk-model.

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Dead space estimates may not be independently associated with 28-day mortality in COVID-19 ARDS

Critical Care ◽

10.1186/s13054-021-03570-0 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Luis Morales-Quinteros ◽

◽

Ary Serpa Neto ◽

Antonio Artigas ◽

Lluis Blanch ◽

...

Keyword(s):

The Netherlands ◽

Dead Space ◽

Risk Model ◽

Direct Method ◽

Secondary Analysis ◽

Case Series ◽

Baseline Risk ◽

Prognostic Information ◽

Increased Risk ◽

End Tidal

Abstract Background Estimates for dead space ventilation have been shown to be independently associated with an increased risk of mortality in the acute respiratory distress syndrome and small case series of COVID-19-related ARDS. Methods Secondary analysis from the PRoVENT-COVID study. The PRoVENT-COVID is a national, multicenter, retrospective observational study done at 22 intensive care units in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The aim was to quantify the dynamics and determine the prognostic value of surrogate markers of wasted ventilation in patients with COVID-19-related ARDS. Results A total of 927 consecutive patients admitted with COVID-19-related ARDS were included in this study. Estimations of wasted ventilation such as the estimated dead space fraction (by Harris–Benedict and direct method) and ventilatory ratio were significantly higher in non-survivors than survivors at baseline and during the following days of mechanical ventilation (p < 0.001). The end-tidal-to-arterial PCO2 ratio was lower in non-survivors than in survivors (p < 0.001). As ARDS severity increased, mortality increased with successive tertiles of dead space fraction by Harris–Benedict and by direct estimation, and with an increase in the VR. The same trend was observed with decreased levels in the tertiles for the end-tidal-to-arterial PCO2 ratio. After adjustment for a base risk model that included chronic comorbidities and ventilation- and oxygenation-parameters, none of the dead space estimates measured at the start of ventilation or the following days were significantly associated with 28-day mortality. Conclusions There is significant impairment of ventilation in the early course of COVID-19-related ARDS but quantification of this impairment does not add prognostic information when added to a baseline risk model. Trial registration: ISRCTN04346342. Registered 15 April 2020. Retrospectively registered.

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Interpregnancy interval in lower versus higher human development index countries: a hypothesis about pregnancy spacing

International Health ◽

10.1093/inthealth/ihaa085 ◽

2020 ◽

Author(s):

Margo S Harrison

Keyword(s):

Regression Model ◽

Human Development Index ◽

Secondary Analysis ◽

Middle Income Country ◽

Income Country ◽

Interpregnancy Interval ◽

Middle Income ◽

Pregnancy Spacing ◽

The Usa ◽

Very High

Abstract Background A secondary analysis was conducted of two separate datasets to observe the association between maternal age and interpregnancy interval (IPI). Methods The IPI in a middle-income country (Guatemala) was compared with that of a very-high-income country (USA) among women with two pregnancies. Results A regression model found that with each increasing year of age, the IPI increases by 1.26 months (p<0.001) in Guatemala. A regression model found that IPI decreased as women aged in the USA. Conclusions It is hypothesized that as countries progress in their development indices, women may delay childbearing, which may result in reduced IPI, as was the case in the USA compared with Guatemala in these datasets.

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Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy

Heart ◽

10.1136/heartjnl-2018-313439 ◽

2018 ◽

Vol 105 (4) ◽

pp. 330-336 ◽

Cited By ~ 3

Author(s):

Veerle Dam ◽

N Charlotte Onland-Moret ◽

W M Monique Verschuren ◽

Jolanda M A Boer ◽

Laura Benschop ◽

...

Keyword(s):

Risk Model ◽

Model Performance ◽

Predictive Performance ◽

Baseline Risk ◽

Hypertensive Disorders Of Pregnancy ◽

Cvd Risk ◽

Hypertensive Disorders ◽

Framingham Risk ◽

History Of ◽

Score Model

ObjectivesCompare the predictive performance of Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs) and Systematic COronary Risk Evaluation (SCORE) model between women with and without a history of hypertensive disorders of pregnancy (hHDP) and determine the effects of recalibration and refitting on predictive performance.MethodsWe included 29 751 women, 6302 with hHDP and 17 369 without. We assessed whether models accurately predicted observed 10-year cardiovascular disease (CVD) risk (calibration) and whether they accurately distinguished between women developing CVD during follow-up and not (discrimination), separately for women with and without hHDP. We also recalibrated (updating intercept and slope) and refitted (recalculating coefficients) the models.ResultsOriginal FRS and PCEs overpredicted 10-year CVD risks, with expected:observed (E:O) ratios ranging from 1.51 (for FRS in women with hHDP) to 2.29 (for PCEs in women without hHDP), while E:O ratios were close to 1 for SCORE. Overprediction attenuated slightly after recalibration for FRS and PCEs in both hHDP groups. Discrimination was reasonable for all models, with C-statistics ranging from 0.70-0.81 (women with hHDP) and 0.72–0.74 (women without hHDP). C-statistics improved slightly after refitting 0.71–0.83 (with hHDP) and 0.73–0.80 (without hHDP). The E:O ratio of the original PCE model was statistically significantly better in women with hHDP compared with women without hHDP.ConclusionsSCORE performed best in terms of both calibration and discrimination, while FRS and PCEs overpredicted risk in women with and without hHDP, but improved after recalibrating and refitting the models. No separate model for women with hHDP seems necessary, despite their higher baseline risk.

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Association of Long-Term Change and Variability in Glycemia with Risk of Incident Heart Failure among Patients with Type 2 Diabetes Mellitus – A Secondary Analysis of the ACCORD Trial

10.2337/figshare.12273155.v2 ◽

2020 ◽

Author(s):

Matthew W. Segar ◽

Kershaw V. Patel ◽

Muthiah Vaduganathan ◽

Melissa C. Caughey ◽

Javed Butler ◽

...

Keyword(s):

Standard Deviation ◽

Secondary Analysis ◽

Glycemic Variability ◽

Baseline Risk ◽

Absolute Difference ◽

Cox Models ◽

Term Change ◽

Alternative Measures

Objective: Evaluate the associations between long-term change and variability in glycemia with risk of HF among patients with T2DM. Research Design and Methods: Among participants with T2DM enrolled in the ACCORD trial, variability in HbA1c was assessed from stabilization of HbA1c following enrollment (8 months) to 3 years of follow-up as follows: average successive variability (ASV=average absolute difference between successive values), coefficient of variation (CV=standard deviation/mean), and standard deviation. Participants with HF at baseline or within 3 years of enrollment were excluded. Adjusted Cox models were used to evaluate the association of % change (from baseline to 3 years of follow-up) and variability in HbA1c over the first 3 years of enrollment and subsequent risk of HF. Results: The study included 8,576 patients. Over a median follow-up of 6.4 years from the end of variability measurements at year 3, 388 patients had an incident HF hospitalization. Substantial changes in HbA1c were significantly associated with higher risk of HF [HR (95% CI) for ≥10% decrease = 1.32 (1.08-1.75), ≥10% increase = 1.55 (1.19-2.04), ref: <10% change in HbA1c]. Higher long-term variability in HbA1c was significantly associated with higher risk of HF [HR (95% CI) per 1 SD of ASV = 1.34 (1.17-1.54)] independent of baseline risk factors and interval changes in cardiometabolic parameters. Consistent patterns of association were observed using alternative measures of glycemic variability. Conclusions: Substantial long-term changes and variability in HbA1c were independently associated with risk of HF among patients with T2DM.

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Co-morbid anaemia and stunting among children of pre-school age in low- and middle-income countries: a syndemic

Public Health Nutrition ◽

10.1017/s136898001800232x ◽

2018 ◽

Vol 22 (1) ◽

pp. 35-43 ◽

Cited By ~ 6

Author(s):

Thach Duc Tran ◽

Beverley-Ann Biggs ◽

Sara Holton ◽

Hau Thi Minh Nguyen ◽

Sarah Hanieh ◽

...

Keyword(s):

Rural Areas ◽

Secondary Analysis ◽

Logistic Models ◽

Demographic And Health Surveys ◽

Healthy Children ◽

Middle Income ◽

Disadvantaged Children ◽

Middle Income Countries ◽

Co Morbidity ◽

Low And Middle Income

AbstractObjectiveTo determine the prevalence of co-morbidity of two important global health challenges, anaemia and stunting, among children aged 6–59 months in low- and middle-income countries.DesignSecondary analysis of data from Demographic and Health Surveys (DHS) conducted 2005–2015. Child stunting and anaemia were defined using current WHO classifications. Sociodemographic characteristics of children with anaemia, stunting and co-morbidity of these conditions were compared with those of ‘healthy’ children in the sample (children who were not stunted and not anaemic) using multiple logistic models.SettingLow- and middle-income countries.SubjectsChildren aged 6–59 months.ResultsData from 193 065 children from forty-three countries were included. The pooled proportion of co-morbid anaemia and stunting was 21·5 (95 % CI 21·2, 21·9) %, ranging from the lowest in Albania (2·6 %; 95 % CI 1·8, 3·7 %) to the highest in Yemen (43·3; 95 % CI 40·6, 46·1 %). Compared with the healthy group, children with co-morbidity were more likely to be living in rural areas, have mothers or main carers with lower educational levels and to live in poorer households. Inequality in children who had both anaemia and stunting was apparent in all countries.ConclusionsCo-morbid anaemia and stunting among young children is highly prevalent in low- and middle-income countries, especially among more disadvantaged children. It is suggested that they be considered under a syndemic framework, the Childhood Anaemia and Stunting (CHAS) Syndemic, which acknowledges the interacting nature of these diseases and the social and environmental factors that promote their negative interaction.

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Video Relay Interpreting and Overcoming Barriers in Health Care for Deaf Users: A Scoping Review (Preprint)

10.2196/preprints.32439 ◽

2021 ◽

Author(s):

Minerva Rivas Velarde ◽

Caroline Jagoe ◽

Jess Cuculick

Keyword(s):

Health Care ◽

Sign Language ◽

Scoping Review ◽

Secondary Analysis ◽

Healthcare Services ◽

Eligibility Criteria ◽

Middle Income ◽

Middle Income Countries ◽

Healthcare Settings ◽

Study Selection

UNSTRUCTURED Abstract Objectives To identify existing evidence regarding the use of Video Remote Interpretation (VRI) in healthcare settings. To assess if VRI technology can enable deaf-users to overcome interpretation barriers and improve communication outcomes between them and health care personnel. Design Scoping review. Data sources Seven medical research databases (Medline, Web of Science, Embase, Google Scholar) from 2006 and bibliographies and citations of relevant papers. Searches included articles in English, Spanish and French. Eligibility criteria for study selection Original articles about the use of VRI for Deaf or Hard of Hearing sign language users (DHH) for, or within, healthcare. Results From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. Fifteen articles were selected for inclusion. Four were literature reviews; four were surveys, three qualitative studies; and one mixed-methods study that combined qualitative and quantitative data, one brief communication, one quality improvement report and one secondary analysis. This scoping review identified a knowledge gap regarding the quality of interpretation and training of sign language interpretation for healthcare. It also shows that this area is under researched and evidence is scant. All evidence was from high-income countries which is particularly problematic given that the majority of DHH persons live in low- and middle-income countries. Conclusions Furthering our understanding on the use of VRI technology is pertinent and relevant. Available literature shows that VRI may enable deaf-users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within healthcare services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screen and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.

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Outcomes associated with anaesthetic techniques for caesarean section in low- and middle-income countries: a secondary analysis of WHO surveys

Scientific Reports ◽

10.1038/s41598-020-66897-8 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Pisake Lumbiganon ◽

Hla Moe ◽

Siriporn Kamsa-ard ◽

Siwanon Rattanakanokchai ◽

Malinee Laopaiboon ◽

...

Keyword(s):

Caesarean Section ◽

Secondary Analysis ◽

Anaesthetic Techniques ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Impact of water fortification with calcium on calcium intake in different countries: a simulation study

Public Health Nutrition ◽

10.1017/s1368980020002232 ◽

2020 ◽

pp. 1-14 ◽

Cited By ~ 1

Author(s):

Gabriela Cormick ◽

Luz Gibbons ◽

Jose M Belizán

Keyword(s):

Simulation Study ◽

Democratic Republic ◽

Age Groups ◽

Lao Pdr ◽

Secondary Analysis ◽

Planning Program ◽

Middle Income ◽

Middle Income Countries ◽

Upper Limit ◽

The Impact

Abstract Objective: To simulate the impact – effectiveness and safety – of water fortification with different concentrations of Ca using the Intake Modelling, Assessment and Planning Program. Design: This is a secondary analysis of national or sub-national dietary intake databases. Setting and Participants: Uganda, Lao People’s Democratic Republic (PDR), Bangladesh, Zambia, Argentina, USA and Italy. Results: We found that for dietary databases assessed from low- and middle-income countries (LMIC), the strategy of fortifying water with 500 mg of Ca/l would decrease the prevalence of low Ca intake in all age groups. We also found that this strategy would be safe as no group would present a percentage of individuals exceeding the upper limit in >2 %, except women aged 19–31 years in Lao PDR, where 6·6 % of women in this group would exceed the upper limit of Ca intake. The same strategy would lead to some groups exceeding the upper limit in USA and Italy. Conclusions: We found that for most LMIC countries, water fortified with Ca could decrease the prevalence of Ca intake inadequacy without exceeding the upper levels of Ca intake.

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