OBJECTIVES: To compare the accuracy of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) Scores in predicting mortality among intensive care unit (ICU) patients with sepsis in a low-income and middle-income country. DESIGN: A multicentre, cross-sectional study. SETTING: A total of 15 adult ICUs throughout Vietnam. PARTICIPANTS: We included all patients aged ≥18 years who were admitted to ICUs for sepsis and who were still in ICUs from 00:00 to 23:59 of the specified study days (ie, 9 January, 3 April, 3 July and 9 October of the year 2019). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was hospital all-cause mortality (hospital mortality). We also defined the secondary outcome as all-cause deaths in the ICU (ICU mortality). RESULTS: Of 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs. SOFA Score (areas under the receiver operating characteristic curve (AUROC): 0.688 (95% CI 0.618 to 0.758); cut-off value≥7.5; PAUROC<0.001) and APACHE II Score (AUROC: 0.689 (95% CI 0.622 to 0.756); cut-off value ≥20.5; PAUROC<0.001) both had a poor discriminatory ability for predicting hospital mortality. However, the discriminatory ability for predicting ICU mortality of SOFA (AUROC: 0.713 (95% CI 0.643 to 0.783); cut-off value≥9.5; PAUROC<0.001) was fair and was better than that of APACHE II Score (AUROC: 0.672 (95% CI 0.603 to 0.742); cut-off value≥18.5; PAUROC<0.001). A SOFA Score≥8 (adjusted OR (AOR): 2.717; 95% CI 1.371 to 5.382) and an APACHE II Score≥21 (AOR: 2.668; 95% CI 1.338 to 5.321) were independently associated with an increased risk of hospital mortality. Additionally, a SOFA Score≥10 (AOR: 2.194; 95% CI 1.017 to 4.735) was an independent predictor of ICU mortality, in contrast to an APACHE II Score≥19, for which this role did not. CONCLUSIONS: In this study, SOFA and APACHE II Scores were worthwhile in predicting mortality among ICU patients with sepsis. However, due to better discrimination for predicting ICU mortality, the SOFA Score was preferable to the APACHE II Score in predicting mortality.Clinical trials registry - India: CTRI/2019/01/016898.

Center for Critical Care Medicine Bach Mai Hospital Hanoi Viet Nam

Center for Emergency Medicine Bach Mai Hospital Hanoi Viet Nam

Department of Critical Care Emergency Medicine and Clinical Toxicology Faculty of Medicine Ho Chi Minh City University of Medicine and Pharmacy Ho Chi Minh City Viet Nam

Department of Emergency and Critical Care Medicine Hanoi Medical University Hanoi Viet Nam

Department of Health Organization and Management Faculty of Public Health Thai Binh University of Medicine and Pharmacy Thai Binh City Thai Binh Viet Nam

Department of Intensive Care and Poison Control Vietnam Czechoslovakia Friendship Hospital Hai Phong City Viet Nam

Department of Intensive Care Medicine Woodlands Health Singapore

Department of Nutrition and Food Safety Faculty of Public Health Thai Binh University of Medicine and Pharmacy Thai Binh City Thai Binh Viet Nam

Division of Respiratory and Critical Care Medicine Department of Medicine National University Hospital National University Health System Singapore

Emergency and Critical Care Department Hanoi Medical University Hospital Hanoi Medical University Hanoi Viet Nam

Emergency Department Hue Central General Hospital Hue City Thua Thien Hue Viet Nam

Emergency Department Thanh Nhan General Hospital Hanoi Viet Nam

Faculty of Medicine University of Medicine and Pharmacy Vietnam National University Hanoi Vietnam

FAST and Chronic Programmes Alexandra Hospital National University Health System Singapore

Intensive Care Department Cho Ray Hospital Ho Chi Minh City Viet Nam

Intensive Care Unit 115 People's Hospital Ho Chi Minh City Viet Nam

Intensive Care Unit Bai Chay General Hospital Ha Long City Quang Ninh Viet Nam

Intensive Care Unit Can Tho Central General Hospital Can Tho Viet Nam

Intensive Care Unit Da Nang Hospital Da Nang City Viet Nam

Intensive Care Unit Dong Da General Hospital Hanoi Viet Nam

Intensive Care Unit Saint Paul General Hospital Hanoi Viet Nam

Intensive Care Unit Thai Nguyen Central General Hospital Thai Nguyen City Thai Nguyen Viet Nam

Intensive Care Unit Vinmec Times City International Hospital Hanoi Viet Nam

Zobrazit více v PubMed

Singer M, Deutschman CS, Seymour CW, et al. . The third International consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:801–10. 10.1001/jama.2016.0287 PubMed DOI PMC

Rudd KE, Johnson SC, Agesa KM, et al. . Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study. Lancet 2020;395:200–11.:S0140-6736(19)32989-7. 10.1016/S0140-6736(19)32989-7 PubMed DOI PMC

Liu V, Escobar GJ, Greene JD, et al. . Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 2014;312:90–2. 10.1001/jama.2014.5804 PubMed DOI

Sakr Y, Jaschinski U, Wittebole X, et al. . Sepsis in intensive care unit patients: worldwide data from the intensive care over nations audit. Open Forum Infect Dis 2018;5:ofy313. 10.1093/ofid/ofy313 PubMed DOI PMC

Torio CM, Moore BJ. National inpatient hospital costs: the most expensive conditions by payer, 2013: statistical brief #204. In: Knutson D, ed. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US), 2006. PubMed

Bauer M, Gerlach H, Vogelmann T, et al. . Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis. Crit Care 2020;24:239. 10.1186/s13054-020-02950-2 PubMed DOI PMC

Schultz MJ, Dunser MW, Dondorp AM, et al. . Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future. Intensive Care Med 2017;43:612–24. 10.1007/s00134-017-4750-z PubMed DOI

Levy MM, Fink MP, Marshall JC, et al. . 2001 sccm/esicm/accp/ats/sis international sepsis definitions conference. Intensive Care Med 2003;29:530–8. 10.1007/s00134-003-1662-x PubMed DOI

Bone RC, Balk RA, Cerra FB, et al. . Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644–55. 10.1378/chest.101.6.1644 PubMed DOI

Knaus WA, Draper EA, Wagner DP, et al. . Apache II: a severity of disease classification system. Crit Care Med 1985;13:818–29. 10.1097/00003246-198510000-00009 PubMed DOI

Capuzzo M, Valpondi V, Sgarbi A, et al. . Validation of severity scoring systems saps II and APACHE II in a single-center population. Intensive Care Med 2000;26:1779–85. 10.1007/s001340000715 PubMed DOI

Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology . Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101:2379–400. 10.1111/j.1572-0241.2006.00856.x PubMed DOI

Evans L, Rhodes A, Alhazzani W, et al. . Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47:1181–247. 10.1007/s00134-021-06506-y PubMed DOI PMC

Vincent J-L, Moreno R, Takala J, et al. . The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996;22:707–10. 10.1007/BF01709751 PubMed DOI

Vincent J-L, de Mendonca A, Cantraine F, et al. . Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units. Critical Care Medicine 1998;26:1793–800. 10.1097/00003246-199811000-00016 PubMed DOI

Ferreira FL, Bota DP, Bross A, et al. . Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754–8. 10.1001/jama.286.14.1754 PubMed DOI

Seymour CW, Liu VX, Iwashyna TJ, et al. . Assessment of clinical criteria for sepsis: for the third International consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:762–74. 10.1001/jama.2016.0288 PubMed DOI PMC

Shankar-Hari M, Phillips GS, Levy ML, et al. . Developing a new definition and assessing new clinical criteria for septic shock: for the third International consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315:775–87. 10.1001/jama.2016.0289 PubMed DOI PMC

World . World development indicators. Washington, D.C., United States: The World Bank Group, 2019. Available: https://databank.worldbank.org/data/download/POP.pdf

WHO . Viet nam SARS-free. 2003. in: weekly epidemiological record [internet]. 2003: 145–6. Available: https://www.who.int/wer/2003/en/wer7818.pdf

South East Asia Infectious Disease Clinical Research Network . Effect of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza: double blind randomised controlled trial. BMJ 2013;346(may30 2):f3039. 10.1136/bmj.f3039 PubMed DOI PMC

World Health Organization . Cumulative number of confirmed human cases for avian influenza A(H5N1) reported to WHO, 2003-2021, 15 april 2021. Geneva, Switzerland: The World Health Organization; 2021. Available: www.who.int/publications/m/item/cumulative-number-of-confirmed-human-cases-for-avian-influenza-a(h5n1)-reported-to-who-2003-2021-15-april-2021

World Health Organization . COVID-19 situation reports in viet nam geneva. Switzerland: The World Health Organization; 2021. Available: www.who.int/vietnam/emergencies/coronavirus-disease-(covid-19)-in-viet-nam/covid-19-situation-reports-in-viet-nam/

Do TV, Manabe T, Vu GV, et al. . Clinical characteristics and mortality risk among critically ill patients with COVID-19 owing to the B.1.617.2 (delta) variant in Vietnam: a retrospective observational study. PLoS One 2023;18:e0279713. 10.1371/journal.pone.0279713 PubMed DOI PMC

Anders KL, Nguyet NM, Chau NVV, et al. . Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam. Am J Trop Med Hyg 2011;84:127–34. 10.4269/ajtmh.2011.10-0476 PubMed DOI PMC

Mai NTH, Hoa NT, Nga TVT, et al. . Streptococcus suis meningitis in adults in Vietnam. Clin Infect Dis 2008;46:659–67. 10.1086/527385 PubMed DOI

Maude RJ, Ngo TD, Tran DT, et al. . Risk factors for malaria in high incidence areas of Viet Nam: a case-control study. Malar J 2021;20:373. 10.1186/s12936-021-03908-7 PubMed DOI PMC

Nguyen KV, Thi Do NT, Chandna A, et al. . Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam. BMC Public Health 2013;13:1158. 10.1186/1471-2458-13-1158 PubMed DOI PMC

Phu VD, Wertheim HFL, Larsson M, et al. . Burden of hospital acquired infections and antimicrobial use in Vietnamese adult intensive care units. PLoS One 2016;11:e0147544. 10.1371/journal.pone.0147544 PubMed DOI PMC

The World . The world bank in vietnam. Washington: The World Bank; 2020. Available: www.worldbank.org/en/country/vietnam/overview

Dat VQ, Long NT, Giang KB, et al. . Healthcare infrastructure capacity to respond to severe acute respiratory infection (SARI) and sepsis in Vietnam: a low-middle income country. J Crit Care 2017;42:109–15.:S0883-9441(17)30405-7. 10.1016/j.jcrc.2017.07.020 PubMed DOI PMC

Chinh LQ, Manabe T, Son DN, et al. . Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam. PLoS One 2019;14:e0221114. 10.1371/journal.pone.0221114 PubMed DOI PMC

Takashima K, Wada K, Tra TT, et al. . A review of Vietnam’s healthcare reform through the direction of healthcare activities (Doha). Environ Health Prev Med 2017;22:74. 10.1186/s12199-017-0682-z PubMed DOI PMC

Asian critical care clinical trials group. In: Management of Sepsis in Asia’s Intensive Care unitS II (MOSAICS II) Study Singapore: Society of Intensive Care Medicine (Singapore). 2019. Available: https://sicm.org.sg/article/YDNc8

Do SN, Luong CQ, Pham DT, et al. . Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of mosaics II study. Sci Rep 2021;11:18924. 10.1038/s41598-021-98165-8 PubMed DOI PMC

Li A, Ling L, Qin H, et al. . Epidemiology, management, and outcomes of sepsis in ICUs among countries of differing national wealth across Asia. Am J Respir Crit Care Med 2022;206:1107–16. 10.1164/rccm.202112-2743OC PubMed DOI

Do SN, Luong CQ, Nguyen MH, et al. . Predictive validity of the quick sequential organ failure assessment (qsofa) score for the mortality in patients with sepsis in Vietnamese intensive care units. PLoS One 2022;17:e0275739. 10.1371/journal.pone.0275739 PubMed DOI PMC

Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 2018;44:925–8. 10.1007/s00134-018-5085-0 PubMed DOI

Thao PTN, Tra TT, Son NT, et al. . Reduction in the IL-6 level at 24 H after admission to the intensive care unit is a survival predictor for Vietnamese patients with sepsis and septic shock: a prospective study. BMC Emerg Med 2018;18:39. 10.1186/s12873-018-0191-4 PubMed DOI PMC

Phua J, Koh Y, Du B, et al. . Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ 2011;342:d3245. 10.1136/bmj.d3245 PubMed DOI PMC

Dewi RS, Radji M, Andalusia R. Evaluation of antibiotic use among sepsis patients in an intensive care unit: a cross-sectional study at a referral hospital in Indonesia. Sultan Qaboos Univ Med J 2018;18:e367–73. 10.18295/squmj.2018.18.03.017 PubMed DOI PMC

Rudd KE, Hantrakun V, Somayaji R, et al. . Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study. J Intensive Care 2019;7:55. 10.1186/s40560-019-0407-z PubMed DOI PMC

Rhodes A, Evans LE, Alhazzani W, et al. . Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017;45:486–552. 10.1097/CCM.0000000000002255 PubMed DOI

Phua J, Lim C-M, Faruq MO, et al. . The story of critical care in Asia: a narrative review. J Intensive Care 2021;9:60. 10.1186/s40560-021-00574-4 PubMed DOI PMC

Vincent J-L, Sakr Y, Singer M, et al. . Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA 2020;323:1478–87. 10.1001/jama.2020.2717 PubMed DOI PMC

Sharma S, Kelly YP, Palevsky PM, et al. . Intensity of renal replacement therapy and duration of mechanical ventilation: secondary analysis of the acute renal failure trial network study. Chest 2020;158:1473–81.:S0012-3692(20)31606-8. 10.1016/j.chest.2020.05.542 PubMed DOI PMC

Elseviers MM, Lins RL, Van der Niepen P, et al. . Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit Care 2010;14:R221. 10.1186/cc9355 PubMed DOI PMC

Barbar SD, Clere-Jehl R, Bourredjem A, et al. . Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med 2018;379:1431–42. 10.1056/NEJMoa1803213 PubMed DOI

Aboshakwa AM, Lalla U, Irusen EM, et al. . Acinetobacter baumannii infection in a medical intensive care unit: the impact of strict infection control. Afr J Thorac Crit Care Med 2019;25. 10.7196/AJTCCM.2019.v25i1.239 PubMed DOI PMC

John AO, Paul H, Vijayakumar S, et al. . Mortality from Acinetobacter infections as compared to other infections among critically ill patients in South India: a prospective cohort study. Indian J Med Microbiol 2020;38:24–31. 10.4103/ijmm.IJMM_19_492 PubMed DOI

Shargian-Alon L, Gafter-Gvili A, Ben-Zvi H, et al. . Risk factors for mortality due to Acinetobacter baumannii bacteremia in patients with hematological malignancies-a retrospective study. Leuk Lymphoma 2019;60:2787–92. 10.1080/10428194.2019.1599113 PubMed DOI