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 Asia

Lal, Sham, Luangraj, Manophab, Keddie, Suzanne H., Ashley, Elizabeth A., Baerenbold, Oliver, Bassat, Quique, Bradley, John, Crump, John A., Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405, Green, Edward, Kain, Kevin C., Olaru, Ioana D., Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200, Roberts, Chrissy h., Mabey, David C.W., Moore, Christopher C., Hopkins, Heidi, Ajanovic, Sara, Amos, Benjamin, Ashley, Elizabeth A., Baerenbold, Oliver, Baghoumina, Stéphanie, Balanza, Núria, Bandason, Tsitsi, Bassat, Quique, Bhattacharyya, Tapan, Blacksell, Stuart D., Boca, Zumilda, Bottomley, Christian, Bradley, John, Bramugy, Justina M., Chandler, Clare IR., Chansamouth, Vilada, Chimenya, Mabvuto, Chipanga, Joseph, Cossa, Anelsio, Crump, John A., Dauya, Ethel, Davis, Catherine, de Lamballerie, Xavier, Dixon, Justin, Douangphachanh, Somyoth, Dubot-Pérès, Audrey, Durkin, Michelle M., Feasey, Nicholas A., Ferrand, Rashida A., Fink, Colin, Fitchett, Elizabeth JA., Gerada, Alessandro, Graves, Stephen R., Green, Edward, Handley, Becca L., Hopkins, Heidi, Hutchison, Coll D., Jaksuwan, Risara, Jervis, Jessica, Jones, Jayne, Kain, Kevin C., Keddie, Suzanne H., Khounpaseuth, Khamxeng, Kranzer, Katharina, Kunlaya, Khamfong, Lal, Pankaj, Lal, Sham, Lalloo, David G., Luangraj, Manophab, Lubell, Yoel, Mabey, David CW., MacPherson, Eleanor, Makoga, Forget, Manichan, Sengchanh, Marlais, Tegwen, Maurer, Florian, Mayxay, Mayfong, Miles, Michael, Mogeni, Polycarp, Mucasse, Campos, Newton, Paul N., Nguyen, Chelsea, Olaru, Ioana D., Phimolsarnnousith, Vilayouth, Picardeau, Mathieu, Roberts, Chrissy H., Sengduangphachanh, Amphone, Sengsavang, Siho, Sibanda, Molly, Singha, Somvai, Stenos, John, Tanganuchitcharnchai, Ampai, Tanvir, Hira, Ussher, James E., Valente, Marta, Voice, Marie A., Vongsouvath, Manivanh, Wamaka, Msopole, Wheat, L Joseph and Yeung, Shunmay (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 Asia'. EClinicalMedicine, Vol 77, e102856.

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Abstract

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.

Item Type:	Article
Subjects:	WB Practice of Medicine > Diagnosis > General Diagnosis > WB 152 Chills. Fever WY Nursing > WY 100.4 Nursing assessment. Nursing diagnosis
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/j.eclinm.2024.102856
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	31 Oct 2024 11:57
Last Modified:	31 Oct 2024 11:57
URI:	https://archive.lstmed.ac.uk/id/eprint/25464

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