Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study

Abstract

ObjectivesWe evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana.DesignProspective cohort studies.Setting and participantsFrom 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome) criteria and suspected infection were enrolled in emergency departments and medical wards at hospitals in Cambodia and Ghana and hospitalised participants with suspected infection were enrolled in the USA. Cox proportional hazards regression was performed, and Harrell’s C-statistic calculated to determine 28-day mortality prediction performance of the quick Sequential Organ Failure Assessment (qSOFA) score ≥2, SIRS score ≥3, National Early Warning Score (NEWS) ≥5, Modified Early Warning Score (MEWS) ≥5 or Universal Vital Assessment (UVA) score ≥2. Screening tools were compared with baseline risk (age and sex) with the Wald test.ResultsThe cohorts included 567 participants (42.9% women) including 187 participants from Kumasi, Ghana, 200 participants from Takeo, Cambodia and 180 participants from Durham, North Carolina in the USA. The pooled mortality was 16.4% at 28 days. The mortality prediction accuracy increased from baseline risk with the MEWS (C-statistic: 0.63, 95% CI 0.58 to 0.68; p=0.002), NEWS (C-statistic: 0.68; 95% CI 0.64 to 0.73; p<0.001), qSOFA (C-statistic: 0.70, 95% CI 0.64 to 0.75; p<0.001), UVA score (C-statistic: 0.73, 95% CI 0.69 to 0.78; p<0.001), but not with SIRS (0.60; 95% CI 0.54 to 0.65; p=0.13). Within individual cohorts, only the UVA score in Ghana performed better than baseline risk (C-statistic: 0.77; 95% CI 0.71 to 0.83; p<0.001).ConclusionsAmong the cohorts, MEWS, NEWS, qSOFA and UVA scores performed better than baseline risk, largely driven by accuracy improvements in Ghana, while SIRS scores did not improve prognostication accuracy. Prognostication scores should be validated within the target population prior to clinical use.

Long-term Mortality Among Hospitalized Adults with Sepsis in Uganda: a Prospective Cohort Study

“…Patients with respiratory failure may be at particularly risk in hospitals without respiratory support including high flow nasal cannula and mechanical ventilation or access to supplemental oxygen upon discharge. Elevated UVA scores, qSOFA scores, and point-of-care lactate were each associated with an increased risk of death consistent with prior studies in LMICs 7,16,24 . Prior research that demonstrated the additive prognostic value of serum lactate in Uganda, Malawi, and Southeast Asia 3,25,26 .…”

“…Persons 18 years of age and older presenting with suspected infection and ≥ 2 modified systemic inflammatory response syndrome (SIRS) criteria (temperature < 36°C or > 38°C, heart rate ≥ 90 beats per minute, or respiratory rate ≥ 20 breaths per minute) were enrolled at Fort Portal Regional Referral Hospital (FPRRH) in Fort Portal, Uganda. SIRS was incorporated in sepsis cohorts 7 prior to Sepsis 3 criteria 8 and maintained for consistency. Adult patients 18 years of age and older presenting at the outpatient department, emergency department, or medical wards were evaluated for enrollment from October 2017 to August 2022.…”

Retrospective Analysis of Blood Biomarkers of Neurological Injury in Human Cases of Viral Infection and Bacterial Sepsis

“…We analyzed patient samples from sepsis studies completed in Cambodia (20) and Ghana (19) to measure changes in UCH-L1 or GFAP as a result of bacterial infection. This study population was comprised of 53 severely ill, hospitalized patients who presented with at least two systemic inflammatory response syndrome criteria and a suspected infection.…”

“…A normal score is ≥ 26, whereas impairment falls into mild (18)(19)(20)(21)(22)(23)(24)(25), moderate (10)(11)(12)(13)(14)(15)(16)(17), and severe (< 10) categories. Previous sepsis studies completed in Ghana (19) provided serum samples collected prospectively from hospitalized cases of sepsis at study enrollment (day 0) and day 28 after enrollment. MoCA-B scores were determined for individuals at study enrollment, upon discharge, on day 28, and 6 and 12 months after discharge, when feasible.…”

“…MoCA-B scoring differentiates among cognitive syndromes by assessing memory, executive function, attention, language, visuospatial parameters, and orientation (21). A normal score is ≥ 26, whereas impairment falls into mild (18)(19)(20)(21)(22)(23)(24)(25), moderate (10)(11)(12)(13)(14)(15)(16)(17), and severe (< 10) categories. Previous sepsis studies completed in Ghana (19) provided serum samples collected prospectively from hospitalized cases of sepsis at study enrollment (day 0) and day 28 after enrollment.…”