A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle-Income Countries: a systematic review and meta-analysis
Background: Clinical scores for sepsis have been primarily developed for, and applied in High-Income Countries. This systematic review and meta-analysis examined the performance of the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), Modified Early W...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S258953702100465X |
| _version_ | 1818892196424712192 |
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| author | Bayode R Adegbite, MD Jean R Edoa, MD Wilfrid F Ndzebe Ndoumba, MD Lia B Dimessa Mbadinga, MD Ghyslain Mombo-Ngoma, PhD Shevin T Jacob, MD Jamie Rylance, PhD Prof. Thomas Hänscheid, PhD Prof. Ayola A Adegnika, PhD Prof. Martin P Grobusch, FRCP |
| author_facet | Bayode R Adegbite, MD Jean R Edoa, MD Wilfrid F Ndzebe Ndoumba, MD Lia B Dimessa Mbadinga, MD Ghyslain Mombo-Ngoma, PhD Shevin T Jacob, MD Jamie Rylance, PhD Prof. Thomas Hänscheid, PhD Prof. Ayola A Adegnika, PhD Prof. Martin P Grobusch, FRCP |
| author_sort | Bayode R Adegbite, MD |
| collection | DOAJ |
| description | Background: Clinical scores for sepsis have been primarily developed for, and applied in High-Income Countries. This systematic review and meta-analysis examined the performance of the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and Universal Vital Assessment (UVA) scores for diagnosis and prediction of mortality in patients with suspected infection in Low-and-Middle-Income Countries. Methods: PubMed, Science Direct, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched until May 18, 2021. Studies reporting the performance of at least one of the above-mentioned scores for predicting mortality in patients of 15 years of age and older with suspected infection or sepsis were eligible. The Quality Assessment of Diagnostic Accuracy Studies tool was used for risk-of-bias assessment. PRISMA guidelines were followed (PROSPERO registration: CRD42020153906). The bivariate random-effects regression model was used to pool the individual sensitivities, specificities and areas-under-the-curve (AUC). Findings: Twenty-four articles (of 5669 identified) with 27,237 patients were eligible for inclusion. qSOFA pooled sensitivity was 0·70 (95% confidence interval [CI] 0·60–0·78), specificity 0·73 (95% CI 0·67–0·79), and AUC 0·77 (95% CI 0·72–0·82). SIRS pooled sensitivity, specificity and AUC were 0·88 (95% CI 0·79 -0·93), 0·34 (95% CI 0·25–0·44), and 0·69 (95% CI 0·50–0·83), respectively. MEWS pooled sensitivity, specificity and AUC were 0·70 (95% CI 0·57 -0·81), 0·61 (95% CI 0·42–0·77), and 0·72 (95% CI 0·64–0·77), respectively. UVA pooled sensitivity, specificity and AUC were 0·49 (95% CI 0·33 -0·65), 0·91(95% CI 0·84–0·96), and 0·76 (95% CI 0·44–0·93), respectively. Significant heterogeneity was observed in the pooled analysis. Interpretation: Individual score performances ranged from poor to acceptable. Future studies should combine selected or modified elements of different scores. Funding: Partially funded by the UK National Institute for Health Research (NIHR) (17/63/42). |
| first_indexed | 2024-12-19T17:52:52Z |
| format | Article |
| id | doaj.art-e68299aa42964563bc28c717933057ef |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-19T17:52:52Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-e68299aa42964563bc28c717933057ef2022-12-21T20:11:53ZengElsevierEClinicalMedicine2589-53702021-12-0142101184A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle-Income Countries: a systematic review and meta-analysisBayode R Adegbite, MD0Jean R Edoa, MD1Wilfrid F Ndzebe Ndoumba, MD2Lia B Dimessa Mbadinga, MD3Ghyslain Mombo-Ngoma, PhD4Shevin T Jacob, MD5Jamie Rylance, PhD6Prof. Thomas Hänscheid, PhD7Prof. Ayola A Adegnika, PhD8Prof. Martin P Grobusch, FRCP9Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, GermanyCentre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, GermanyCentre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, GabonCentre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, GabonCentre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, GermanyDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool; Walimu, Kampala, UgandaDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool; Malawi-Liverpool-Wellcome Trust, Chichiri, Blantyre, MalawiInstituto de Microbiologica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PortugalCentre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Department of Parasitology, Leiden University Medical Center, Leiden, The NetherlandsCentre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; MasangaMedical Research Unit, Masanga, Sierra Leone; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Correspondence: Prof. Martin P. Grobusch, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands, Phone: +31 6 566 4380Background: Clinical scores for sepsis have been primarily developed for, and applied in High-Income Countries. This systematic review and meta-analysis examined the performance of the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and Universal Vital Assessment (UVA) scores for diagnosis and prediction of mortality in patients with suspected infection in Low-and-Middle-Income Countries. Methods: PubMed, Science Direct, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched until May 18, 2021. Studies reporting the performance of at least one of the above-mentioned scores for predicting mortality in patients of 15 years of age and older with suspected infection or sepsis were eligible. The Quality Assessment of Diagnostic Accuracy Studies tool was used for risk-of-bias assessment. PRISMA guidelines were followed (PROSPERO registration: CRD42020153906). The bivariate random-effects regression model was used to pool the individual sensitivities, specificities and areas-under-the-curve (AUC). Findings: Twenty-four articles (of 5669 identified) with 27,237 patients were eligible for inclusion. qSOFA pooled sensitivity was 0·70 (95% confidence interval [CI] 0·60–0·78), specificity 0·73 (95% CI 0·67–0·79), and AUC 0·77 (95% CI 0·72–0·82). SIRS pooled sensitivity, specificity and AUC were 0·88 (95% CI 0·79 -0·93), 0·34 (95% CI 0·25–0·44), and 0·69 (95% CI 0·50–0·83), respectively. MEWS pooled sensitivity, specificity and AUC were 0·70 (95% CI 0·57 -0·81), 0·61 (95% CI 0·42–0·77), and 0·72 (95% CI 0·64–0·77), respectively. UVA pooled sensitivity, specificity and AUC were 0·49 (95% CI 0·33 -0·65), 0·91(95% CI 0·84–0·96), and 0·76 (95% CI 0·44–0·93), respectively. Significant heterogeneity was observed in the pooled analysis. Interpretation: Individual score performances ranged from poor to acceptable. Future studies should combine selected or modified elements of different scores. Funding: Partially funded by the UK National Institute for Health Research (NIHR) (17/63/42).http://www.sciencedirect.com/science/article/pii/S258953702100465Xlow-and-middle-income countries (LMICs)sepsisseverity scoresqSOFASIRSMEWS |
| spellingShingle | Bayode R Adegbite, MD Jean R Edoa, MD Wilfrid F Ndzebe Ndoumba, MD Lia B Dimessa Mbadinga, MD Ghyslain Mombo-Ngoma, PhD Shevin T Jacob, MD Jamie Rylance, PhD Prof. Thomas Hänscheid, PhD Prof. Ayola A Adegnika, PhD Prof. Martin P Grobusch, FRCP A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle-Income Countries: a systematic review and meta-analysis EClinicalMedicine low-and-middle-income countries (LMICs) sepsis severity scores qSOFA SIRS MEWS |
| title | A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle-Income Countries: a systematic review and meta-analysis |
| title_full | A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle-Income Countries: a systematic review and meta-analysis |
| title_fullStr | A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle-Income Countries: a systematic review and meta-analysis |
| title_full_unstemmed | A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle-Income Countries: a systematic review and meta-analysis |
| title_short | A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle-Income Countries: a systematic review and meta-analysis |
| title_sort | comparison of different scores for diagnosis and mortality prediction of adults with sepsis in low and middle income countries a systematic review and meta analysis |
| topic | low-and-middle-income countries (LMICs) sepsis severity scores qSOFA SIRS MEWS |
| url | http://www.sciencedirect.com/science/article/pii/S258953702100465X |
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