Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis
© 2019 Teparrukkul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Sepsis can be caused by malaria infect...
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th-mahidol.499112020-01-27T14:57:25Z Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis Prapit Teparrukkul Viriya Hantrakun Mallika Imwong Nittaya Teerawattanasook Gumphol Wongsuvan Nicholas P.J. Day Arjen M. Dondorp T. Eoin West Direk Limmathurotsakul University of Oxford University of Washington, Seattle Mahidol University Sunpasitthiprasong Hospital Agricultural and Biological Sciences Biochemistry, Genetics and Molecular Biology © 2019 Teparrukkul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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<0.001). Of 80 severe malaria patients, 2 (2.5%), 11 (14%), 62 (77.5%) and 5 (6%), presented with qSOFA scores of 0, 1, 2 and 3, respectively. Twenty eight-day mortality was 1.3% (2/153). In conclusion, qSOFA and SOFA can serve as markers of disease severity in adults with malarial sepsis. Patients presenting with a qSOFA score of 1 may also require careful evaluation for sepsis; including diagnosis of cause of infection, initiation of medical intervention, and consideration for referral as appropriate. 2020-01-27T07:30:28Z 2020-01-27T07:30:28Z 2019-01-01 Article PLoS ONE. Vol.14, No.10 (2019) 10.1371/journal.pone.0223457 19326203 2-s2.0-85073110000 https://repository.li.mahidol.ac.th/handle/123456789/49911 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85073110000&origin=inward |
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Agricultural and Biological Sciences Biochemistry, Genetics and Molecular Biology Prapit Teparrukkul Viriya Hantrakun Mallika Imwong Nittaya Teerawattanasook Gumphol Wongsuvan Nicholas P.J. Day Arjen M. Dondorp T. Eoin West Direk Limmathurotsakul Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis |
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© 2019 Teparrukkul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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<0.001). Of 80 severe malaria patients, 2 (2.5%), 11 (14%), 62 (77.5%) and 5 (6%), presented with qSOFA scores of 0, 1, 2 and 3, respectively. Twenty eight-day mortality was 1.3% (2/153). In conclusion, qSOFA and SOFA can serve as markers of disease severity in adults with malarial sepsis. Patients presenting with a qSOFA score of 1 may also require careful evaluation for sepsis; including diagnosis of cause of infection, initiation of medical intervention, and consideration for referral as appropriate. |
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University of Oxford |
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University of Oxford Prapit Teparrukkul Viriya Hantrakun Mallika Imwong Nittaya Teerawattanasook Gumphol Wongsuvan Nicholas P.J. Day Arjen M. Dondorp T. Eoin West Direk Limmathurotsakul |
format |
Article |
author |
Prapit Teparrukkul Viriya Hantrakun Mallika Imwong Nittaya Teerawattanasook Gumphol Wongsuvan Nicholas P.J. Day Arjen M. Dondorp T. Eoin West Direk Limmathurotsakul |
author_sort |
Prapit Teparrukkul |
title |
Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis |
title_short |
Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis |
title_full |
Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis |
title_fullStr |
Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis |
title_full_unstemmed |
Utility of qSOFA and modified SOFA in severe malaria presenting as sepsis |
title_sort |
utility of qsofa and modified sofa in severe malaria presenting as sepsis |
publishDate |
2020 |
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https://repository.li.mahidol.ac.th/handle/123456789/49911 |
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1763490385413275648 |