• Vu Quoc Dat, Nguyen Thanh Long, Vu Ngoc Hieu, Nguyen Dinh Hong Phuc, Kinh Nguyen Van NV National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam., Nguyen Vu Trung, H Rogier van Doorn, Ana Bonell, and Behzad Nadjm.
• Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam. datvq@hmu.edu.vn.
• Bmc Infect Dis. 2018 Oct 26; 18 (1): 535.

BackgroundCommunity acquired bloodstream infection (CABSI) in low- and middle income countries is associated with a high mortality. This study describes the clinical manifestations, laboratory findings and correlation of SOFA and qSOFA with mortality in patients with CABSI in northern Vietnam.MethodsThis was a retrospective study of 393 patients with at least one positive blood culture with not more than one bacterium taken within 48 h of hospitalisation. Clinical characteristic and laboratory results from the first 24 h in hospital were collected. SOFA and qSOFA scores were calculated and their validity in this setting was evaluated.ResultsAmong 393 patients with bacterial CABSI, approximately 80% (307/393) of patients had dysfunction of one or more organ on admission to the study hospital with the most common being that of coagulation (57.1% or 226/393). SOFA performed well in prediction of mortality in those patients initially admitted to the critical care unit (AUC 0.858, 95%CI 0.793-0.922) but poor in those admitted to medical wards (AUC 0.667, 95%CI 0.577-0.758). In contrast qSOFA had poor predictive validity in both settings (AUC 0.692, 95%CI 0.605-0.780 and AUC 0.527, 95%CI 0.424-0.630, respectively). The overall case fatality rate was 28%. HIV infection (HR = 3.145, p = 0.001), neutropenia (HR = 2.442, p = 0.002), SOFA score 1-point increment (HR = 1.19, p < 0.001) and infection with Enterobacteriaceae (HR = 1.722, p = 0.037) were independent risk factors for in-hospital mortality.ConclusionsOrgan dysfunction was common among Vietnamese patients with CABSI and associated with high case fatality. SOFA and qSOFA both need to be further validated in this setting.

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