Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis

Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis
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DOI：
10.1371/journal.pone.0223457
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发表时间：
2019-10-09
期刊：
PLOS ONE
影响因子：
3.7
通讯作者：
Limmathurotsakul, Direk
Limmathurotsakul, Direk
中科院分区：
综合性期刊3区
文献类型：
--
作者：
Teparrukkul, Prapit;Hantrakun, Viriya;Limmathurotsakul, Direk

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脓毒症可由疟疾感染引起，但对快速序贯（脓毒症相关）器官衰竭评估（qSOFA）和SOFA评分在疟疾中的实用性知之甚少。我们从2013年3月至2017年2月进行了一项前瞻性观察性研究，以检查泰国东北部乌汶市一家三级护理医院因社区获得性感染（乌汶败血症）而入院的成年人。如果受试者在入院后24小时内的改良SOFA评分>= 2，则将其归类为患有脓毒症。储存血清，随后使用巢式PCR测定法检测疟原虫。严重疟疾的定义采用世界卫生组织修订的标准。在入组的4，989例患者中，153例患者（3%）为恶性疟原虫（74例[48%]）、间日疟原虫（69例[45%]）或两种微生物（10例[7%]）PCR阳性。在153名疟疾患者中，80名是出现脓毒症的严重疟疾患者，70名是出现脓毒症的非严重疟疾患者，3名是没有出现脓毒症的非严重疟疾患者。改良的SOFA评分（中位数5; IQR 4-6;范围1-18）与疟疾严重程度（由患者满足的世界卫生组织严重程度标准的数量确定）密切相关（斯皮尔曼rho = 0.61，p
Sepsis can be caused by malaria infection, but little is known about the utility of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) and SOFA score in malaria. We conducted a prospective observational study from March 2013 to February 2017 to examine adults admitted with community-acquired infection in a tertiary-care hospital in Ubon Ratchathani, Northeast Thailand (Ubon-sepsis). Subjects were classified as having sepsis if they had a modified SOFA score >= 2 within 24 hours of admission. Serum was stored and later tested for malaria parasites using a nested PCR assay. Presence of severe malaria was defined using modified World Health Organization criteria. Of 4,989 patients enrolled, 153 patients (3%) were PCR positive for either Plasmodium falciparum (74 [48%]), P. vivax (69 [45%]), or both organisms (10 [7%]). Of 153 malaria patients, 80 were severe malaria patients presenting with sepsis, 70 were non-severe malaria patients presenting with sepsis, and three were non-severe malaria patients presenting without sepsis. The modified SOFA score (median 5; IQR 4-6; range 1-18) was strongly correlated with malaria severity determined by the number of World Health Organization severity criteria satisfied by the patient (Spearman's rho = 0.61, p