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

Bayode R. Adegbite; Jean R. Edoa; Wilfrid F. Ndzebe Ndoumba; Lia B. Dimessa Mbadinga; Ghyslain Mombo-Ngoma; Shevin Jacob; Jamie Rylance; Thomas Hänscheid; Ayola A. Adegnika; Martin P. Grobusch

doi:10.1016/j.eclinm.2021.101184

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

Bayode R. Adegbite
, Jean R. Edoa
, Wilfrid F. Ndzebe Ndoumba
, Lia B. Dimessa Mbadinga
, Ghyslain Mombo-Ngoma
, Shevin Jacob
, Jamie Rylance
, Thomas Hänscheid
, Ayola A. Adegnika
, Martin P. Grobusch

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

38 Citations (Scopus)

Abstract

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).

Original language	English
Article number	101184
Journal	eClinicalMedicine
Volume	42
Early online date	30 Oct 2021
DOIs	https://doi.org/10.1016/j.eclinm.2021.101184
Publication status	Published - 1 Dec 2021

Keywords

low-and-middle-income countries (LMICs)
MEWS
qSOFA
sepsis
severity scores
SIRS
UVA

Themes

Tuberculosis and Antimicrobial Resistance

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PIIS258953702100465XFinal published version, 1.14 MBLicence: CC BY-NC-ND

Cite this

Adegbite, B. R., Edoa, J. R., Ndzebe Ndoumba, W. F., Dimessa Mbadinga, L. B., Mombo-Ngoma, G., Jacob, S., Rylance, J., Hänscheid, T., Adegnika, A. A., & Grobusch, M. P. (2021). 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, 42, Article 101184. https://doi.org/10.1016/j.eclinm.2021.101184

@article{eb63ea6da47341f7a7fa16c73c0ffc56,

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",

abstract = "BackgroundClinical 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.MethodsPubMed, 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).FindingsTwenty-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.InterpretationIndividual score performances ranged from poor to acceptable. Future studies should combine selected or modified elements of different scores.FundingPartially funded by the UK National Institute for Health Research (NIHR) (17/63/42).",

keywords = "low-and-middle-income countries (LMICs), MEWS, qSOFA, sepsis, severity scores, SIRS, UVA",

author = "Adegbite, \{Bayode R.\} and Edoa, \{Jean R.\} and \{Ndzebe Ndoumba\}, \{Wilfrid F.\} and \{Dimessa Mbadinga\}, \{Lia B.\} and Ghyslain Mombo-Ngoma and Shevin Jacob and Jamie Rylance and Thomas H{\"a}nscheid and Adegnika, \{Ayola A.\} and Grobusch, \{Martin P.\}",

year = "2021",

month = dec,

day = "1",

doi = "10.1016/j.eclinm.2021.101184",

language = "English",

volume = "42",

journal = "eClinicalMedicine",

issn = "2589-5370",

publisher = "Elsevier Ltd",

}

Adegbite, BR, Edoa, JR, Ndzebe Ndoumba, WF, Dimessa Mbadinga, LB, Mombo-Ngoma, G, Jacob, S, Rylance, J, Hänscheid, T, Adegnika, AA & Grobusch, MP 2021, '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, vol. 42, 101184. https://doi.org/10.1016/j.eclinm.2021.101184

TY - JOUR

T1 - 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

AU - Adegbite, Bayode R.

AU - Edoa, Jean R.

AU - Ndzebe Ndoumba, Wilfrid F.

AU - Dimessa Mbadinga, Lia B.

AU - Mombo-Ngoma, Ghyslain

AU - Jacob, Shevin

AU - Rylance, Jamie

AU - Hänscheid, Thomas

AU - Adegnika, Ayola A.

AU - Grobusch, Martin P.

PY - 2021/12/1

Y1 - 2021/12/1

N2 - BackgroundClinical 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.MethodsPubMed, 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).FindingsTwenty-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.InterpretationIndividual score performances ranged from poor to acceptable. Future studies should combine selected or modified elements of different scores.FundingPartially funded by the UK National Institute for Health Research (NIHR) (17/63/42).

AB - BackgroundClinical 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.MethodsPubMed, 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).FindingsTwenty-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.InterpretationIndividual score performances ranged from poor to acceptable. Future studies should combine selected or modified elements of different scores.FundingPartially funded by the UK National Institute for Health Research (NIHR) (17/63/42).

KW - low-and-middle-income countries (LMICs)

KW - MEWS

KW - qSOFA

KW - sepsis

KW - severity scores

KW - SIRS

KW - UVA

U2 - 10.1016/j.eclinm.2021.101184

DO - 10.1016/j.eclinm.2021.101184

M3 - Article

SN - 2589-5370

VL - 42

JO - eClinicalMedicine

JF - eClinicalMedicine

M1 - 101184

ER -

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

Abstract

Keywords

Themes

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