EClinicalMedicine (Nov 2024)

Predicting mortality in febrile adults: comparative performance of the MEWS, qSOFA, and UVA scores using prospectively collected data among patients in four health-care sites in sub-Saharan Africa and South-Eastern AsiaResearch in context

  • Sham Lal,
  • Manophab Luangraj,
  • Suzanne H. Keddie,
  • Elizabeth A. Ashley,
  • Oliver Baerenbold,
  • Quique Bassat,
  • John Bradley,
  • John A. Crump,
  • Nicholas A. Feasey,
  • Edward W. Green,
  • Kevin C. Kain,
  • Ioana D. Olaru,
  • David G. Lalloo,
  • Chrissy h. Roberts,
  • David C.W. Mabey,
  • Christopher C. Moore,
  • Heidi Hopkins,
  • Sara Ajanovic,
  • Benjamin Amos,
  • Elizabeth A. Ashley,
  • Oliver Baerenbold,
  • Stéphanie Baghoumina,
  • Núria Balanza,
  • Tsitsi Bandason,
  • Quique Bassat,
  • Tapan Bhattacharyya,
  • Stuart D. Blacksell,
  • Zumilda Boca,
  • Christian Bottomley,
  • John Bradley,
  • Justina M. Bramugy,
  • Clare IR. Chandler,
  • Vilada Chansamouth,
  • Mabvuto Chimenya,
  • Joseph Chipanga,
  • Anelsio Cossa,
  • John A. Crump,
  • Ethel Dauya,
  • Catherine Davis,
  • Xavier de Lamballerie,
  • Justin Dixon,
  • Somyoth Douangphachanh,
  • Audrey Dubot-Pérès,
  • Michelle M. Durkin,
  • Nicholas A. Feasey,
  • Rashida A. Ferrand,
  • Colin Fink,
  • Elizabeth JA. Fitchett,
  • Alessandro Gerada,
  • Stephen R. Graves,
  • Edward Green,
  • Becca L. Handley,
  • Heidi Hopkins,
  • Coll D. Hutchison,
  • Risara Jaksuwan,
  • Jessica Jervis,
  • Jayne Jones,
  • Kevin C. Kain,
  • Suzanne H. Keddie,
  • Khamxeng Khounpaseuth,
  • Katharina Kranzer,
  • Khamfong Kunlaya,
  • Pankaj Lal,
  • Sham Lal,
  • David G. Lalloo,
  • Manophab Luangraj,
  • Yoel Lubell,
  • David CW. Mabey,
  • Eleanor MacPherson,
  • Forget Makoga,
  • Sengchanh Manichan,
  • Tegwen Marlais,
  • Florian Maurer,
  • Mayfong Mayxay,
  • Michael Miles,
  • Polycarp Mogeni,
  • Campos Mucasse,
  • Paul N. Newton,
  • Chelsea Nguyen,
  • Ioana D. Olaru,
  • Vilayouth Phimolsarnnousith,
  • Mathieu Picardeau,
  • Chrissy H. Roberts,
  • Amphone Sengduangphachanh,
  • Siho Sengsavang,
  • Molly Sibanda,
  • Somvai Singha,
  • John Stenos,
  • Ampai Tanganuchitcharnchai,
  • Hira Tanvir,
  • James E. Ussher,
  • Marta Valente,
  • Marie A. Voice,
  • Manivanh Vongsouvath,
  • Msopole Wamaka,
  • L Joseph Wheat,
  • Shunmay Yeung

Journal volume & issue
Vol. 77
p. 102856

Abstract

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Summary: Background: Clinical severity scores can identify patients at risk of severe disease and death, and improve patient management. The modified early warning score (MEWS), the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and the Universal Vital Assessment (UVA) were developed as risk-stratification tools, but they have not been fully validated in low-resource settings where fever and infectious diseases are frequent reasons for health care seeking. We assessed the performance of MEWS, qSOFA, and UVA in predicting mortality among febrile patients in the Lao PDR, Malawi, Mozambique, and Zimbabwe. Methods: We prospectively enrolled in- and outpatients aged ≥ 15 years who presented with fever (≥37.5 °C) from June 2018–March 2021. We collected clinical data to calculate each severity score. The primary outcome was mortality 28 days after enrolment. The predictive performance of each score was determined using area under the receiver operating curve (AUC). Findings: A total of 2797 participants were included in this analysis. The median (IQR) age was 32 (24–43) years, 38% were inpatients, and 60% (1684/2797) were female. By the time of follow-up, 7% (185/2797) had died. The AUC (95% CI) for MEWS, qSOFA and UVA were 0.67 (0.63–0.71), 0.68 (0.64–0.72), and 0.82 (0.79–0.85), respectively. The AUC comparison found UVA outperformed both MEWS (p < 0.001) and qSOFA (p < 0.001). Interpretation: We showed that the UVA score performed best in predicting mortality among febrile participants by the time follow-up compared with MEWS and qSOFA, across all four study sites. The UVA score could be a valuable tool for early identification, triage, and initial treatment guidance of high-risk patients in resource-limited clinical settings. Funding: FCDO.

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