Investigating SOFA, delta-SOFA and MPM-III for mortality prediction among critically ill patients at a private tertiary hospital ICU in Kenya: A retrospective cohort study

Abstract

Background Outcomes in well-resourced, intensive care units (ICUs) in Kenya are thought to be comparable to those in high-income countries (HICs) but risk-adjusted mortality data is unavailable. We undertook an evaluation of the Aga Khan University Hospital, Nairobi ICU to analyze patient clinical-demographic characteristics, compare the performance of Sequential Organ Failure Assessment (SOFA), delta-SOFA at 48 hours and Mortality Prediction Model-III (MPM-III) mortality prediction systems, and identify factors associated with increased risk of mortality. Methods A retrospective cohort study was conducted of adult patients admitted to the ICU between January 2015 and September 2017. SOFA and MPM-III scores were determined at admission and SOFA repeated at 48 hours. Results Approximately 33% of patients did not meet ICU admission criteria. Mortality among the population of critically ill patients in the ICU was 31.7%, most of whom were male (61.4%) with a median age of 53.4 years. High adjusted odds of mortality were found among critically ill patients with leukemia (aOR 6.32, p<0.01), tuberculosis (aOR 3.96, p<0.01), post-cardiac arrest (aOR 3.57, p<0.01), admissions from the step-down unit (aOR 3.13, p<0.001), acute kidney injury (aOR 2.97, p<0.001) and metastatic cancer (aOR 2.45, p = 0.04). The area under the receiver-operating characteristic (ROC) curve of admission SOFA was 0.77 (95% CI, 0.73-0.81), MPM-III 0.74 (95% CI, 0.69-0.79), delta-SOFA 0.69 (95% CI, 0.63-0.75) and 48-hour SOFA 0.83 (95% CI, 0.79-0.87). The difference between SOFA at 48 hours

Predictive Value of New Sequential Organ Failure Assessment (SOFA) Score of Mortality in Critically Ill Patients in Emergency Department in Suez Canal University Hospital

“…These results were not the same as the study's findings by Lukoko et al (9) , which showed that most of the studied patients were males (61.4%), with a median age of 53 years. This study showed that diabetes and hypertension were the predominant chronic illnesses in the studied population.…”

Performance in mortality prediction of SAPS 3 And MPM-III scores among adult patients admitted to the ICU of a private tertiary referral hospital in Tanzania: a retrospective cohort study

“…MPM 0 -III has been externally validated in various ICUs in North America ( Higgins et al, 2007 ; Kuzniewicz et al, 2008 ; Higgins et al, 2009 ) and has shown to have good discrimination which was similar to our study finding. However, a study done at Aga Khan University Hospital, Nairobi, Kenya ( Lukoko et al, 2020 ) and two public ICUs in Rwanda ( Riviello et al, 2016 ) showed MPM 0 -III to have fair discrimination amongst their cohort. This observed difference in discrimination may be due to the effect of differences in proportion of case mixes between the study settings.…”

“…Earlier studies mentioned that were conducted in Sub-Saharan Africa have produced contrasting results. The MPM 0 -III was well calibrated amongst the critical ill patients admitted to the ICU of the Aga Khan University Hospital, Nairobi ( Lukoko et al, 2020 ) but showed poor calibration amongst all adult patients admitted to Rwanda’s two public ICUs ( Riviello et al, 2016 ). These findings highlight the similar treatment protocols and interventions between two sister hospitals located in different geographical regions.…”

“…MPM 0 -III has been a well-studied tool in East Africa. Nevertheless, its performance in predicting outcomes among critically ill patients admitted to ICU’s in Kenya ( Lukoko et al, 2020 ) and Rwanda ( Riviello et al, 2016 ) are contradictory. External validation of SAPS 3 among patients admitted to the ICU’s in Austria, Brazil and Italy reported that SAPS 3 had a good ability to predict outcomes but performed poorly across all probabilities of death when compared with APACHE-IV and MPM 0 -III ( Poole et al, 2009 ; Nassar Jr et al, 2012 ; Metnitz et al, 2009 ).…”

The State of Critical Care Provision in Low-Resource Environments

“…14 This same group subsequently demonstrated that even the presence of a well-resourced ICU in an LMIC is not enough to guarantee good patient outcomes in the absence of protocolized care. 15 Protocolized care is urgently needed in low-resource environments to improve critical care outcomes.…”