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

Sham Lal; Manophab Luangraj; Suzanne H. Keddie; Elizabeth A. Ashley; Oliver Baerenbold; Quique Bassat; John Bradley; John A. Crump; Nick Feasey; Edward Green; Kevin C. Kain; Ioana D. Olaru; David Lalloo; Chrissyh Roberts; David C.W. Mabey; Christopher C. Moore; Heidi Hopkins; Sara Ajanovic; Benjamin Amos; Stéphanie Baghoumina; Núria Balanza; Tsitsi Bandason; Tapan Bhattacharyya; Stuart D. Blacksell; Zumilda Boca; Christian Bottomley; Justina M. Bramugy; Clare IR Chandler; Vilada Chansamouth; Mabvuto Chimenya; Joseph Chipanga; Anelsio Cossa; Ethel Dauya; Catherine Davis; Xavier de Lamballerie; Justin Dixon; Somyoth Douangphachanh; Audrey Dubot-Pérès; Michelle M. Durkin; Rashida A. Ferrand; Colin Fink; Elizabeth JA Fitchett; Alessandro Gerada; Stephen R. Graves; Becca L. Handley; Coll D. Hutchison; Risara Jaksuwan; Jessica Jervis; Jayne Jones; Khamxeng Khounpaseuth; Katharina Kranzer; Khamfong Kunlaya; Pankaj Lal; 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; Vilayouth Phimolsarnnousith; Mathieu Picardeau; 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

doi:10.1016/j.eclinm.2024.102856

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

Sham Lal, Manophab Luangraj, Suzanne H. Keddie, Elizabeth A. Ashley, Oliver Baerenbold, Quique Bassat, John Bradley, John A. Crump, Nick Feasey, Edward Green, Kevin C. Kain, Ioana D. Olaru, David Lalloo, Chrissyh Roberts, David C.W. Mabey, Christopher C. Moore, Heidi Hopkins, Sara Ajanovic, Benjamin Amos, Stéphanie BaghouminaNúria Balanza, Tsitsi Bandason, Tapan Bhattacharyya, Stuart D. Blacksell, Zumilda Boca, Christian Bottomley, Justina M. Bramugy, Clare IR Chandler, Vilada Chansamouth, Mabvuto Chimenya, Joseph Chipanga, Anelsio Cossa, Ethel Dauya, Catherine Davis, Xavier de Lamballerie, Justin Dixon, Somyoth Douangphachanh, Audrey Dubot-Pérès, Michelle M. Durkin, Rashida A. Ferrand, Colin Fink, Elizabeth JA Fitchett, Alessandro Gerada, Stephen R. Graves, Becca L. Handley, Coll D. Hutchison, Risara Jaksuwan, Jessica Jervis, Jayne Jones, Khamxeng Khounpaseuth, Katharina Kranzer, Khamfong Kunlaya, Pankaj Lal, 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, Vilayouth Phimolsarnnousith, Mathieu Picardeau, 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

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

5 Citations (Scopus)

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.

Original language	English
Article number	102856
Pages (from-to)	e102856
Journal	eClinicalMedicine
Volume	77
Early online date	4 Oct 2024
DOIs	https://doi.org/10.1016/j.eclinm.2024.102856
Publication status	Published - 1 Nov 2024

Keywords

Area under the curve
Fever
MEWS
Mortality
Prognostic scores
qSOFA
Severity scores
UVA

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.eclinm.2024.102856Licence: CC BY

1-s2Final published version, 748 KBLicence: CC BY

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this

Lal, S., Luangraj, M., Keddie, S. H., Ashley, E. A., Baerenbold, O., Bassat, Q., Bradley, J., Crump, J. A., Feasey, N., Green, E., Kain, K. C., Olaru, I. D., Lalloo, D., Roberts, C., Mabey, D. C. W., Moore, C. C., Hopkins, H., Ajanovic, S., Amos, B., ... Yeung, S. (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, 77, e102856. Article 102856. https://doi.org/10.1016/j.eclinm.2024.102856

@article{188c799b3179430b8b3a3af9601397a6,

title = "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",

abstract = "BackgroundClinical 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.MethodsWe 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).FindingsA 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).InterpretationWe 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.",

keywords = "Area under the curve, Fever, MEWS, Mortality, Prognostic scores, qSOFA, Severity scores, UVA",

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

year = "2024",

month = nov,

day = "1",

doi = "10.1016/j.eclinm.2024.102856",

language = "English",

volume = "77",

pages = "e102856",

journal = "eClinicalMedicine",

issn = "2589-5370",

publisher = "Elsevier Ltd",

}

Lal, S, Luangraj, M, Keddie, SH, Ashley, EA, Baerenbold, O, Bassat, Q, Bradley, J, Crump, JA, Feasey, N, Green, E, Kain, KC, Olaru, ID, Lalloo, D, Roberts, C, Mabey, DCW, Moore, CC, Hopkins, H, Ajanovic, S, Amos, B, Baghoumina, S, Balanza, N, Bandason, T, Bhattacharyya, T, Blacksell, SD, Boca, Z, Bottomley, C, Bramugy, JM, Chandler, CIR, Chansamouth, V, Chimenya, M, Chipanga, J, Cossa, A, Dauya, E, Davis, C, de Lamballerie, X, Dixon, J, Douangphachanh, S, Dubot-Pérès, A, Durkin, MM, Ferrand, RA, Fink, C, Fitchett, EJA, Gerada, A, Graves, SR, Handley, BL, Hutchison, CD, Jaksuwan, R, Jervis, J, Jones, J, Khounpaseuth, K, Kranzer, K, Kunlaya, K, Lal, P, Lubell, Y, Mabey, DCW, MacPherson, E, Makoga, F, Manichan, S, Marlais, T, Maurer, F, Mayxay, M, Miles, M, Mogeni, P, Mucasse, C, Newton, PN, Nguyen, C, Phimolsarnnousith, V, Picardeau, M, Sengduangphachanh, A, Sengsavang, S, Sibanda, M, Singha, S, Stenos, J, Tanganuchitcharnchai, A, Tanvir, H, Ussher, JE, Valente, M, Voice, MA, Vongsouvath, M, Wamaka, M, Wheat, LJ & Yeung, S 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, 102856, pp. e102856. https://doi.org/10.1016/j.eclinm.2024.102856

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. et al.
In: eClinicalMedicine, Vol. 77, 102856, 01.11.2024, p. e102856.

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

TY - JOUR

T1 - 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

AU - Lal, Sham

AU - Luangraj, Manophab

AU - Keddie, Suzanne H.

AU - Ashley, Elizabeth A.

AU - Baerenbold, Oliver

AU - Bassat, Quique

AU - Bradley, John

AU - Crump, John A.

AU - Feasey, Nick

AU - Green, Edward

AU - Kain, Kevin C.

AU - Olaru, Ioana D.

AU - Lalloo, David

AU - Roberts, Chrissyh

AU - Mabey, David C.W.

AU - Moore, Christopher C.

AU - Hopkins, Heidi

AU - Ajanovic, Sara

AU - Amos, Benjamin

AU - Baghoumina, Stéphanie

AU - Balanza, Núria

AU - Bandason, Tsitsi

AU - Bhattacharyya, Tapan

AU - Blacksell, Stuart D.

AU - Boca, Zumilda

AU - Bottomley, Christian

AU - Bramugy, Justina M.

AU - Chandler, Clare IR

AU - Chansamouth, Vilada

AU - Chimenya, Mabvuto

AU - Chipanga, Joseph

AU - Cossa, Anelsio

AU - Dauya, Ethel

AU - Davis, Catherine

AU - de Lamballerie, Xavier

AU - Dixon, Justin

AU - Douangphachanh, Somyoth

AU - Dubot-Pérès, Audrey

AU - Durkin, Michelle M.

AU - Ferrand, Rashida A.

AU - Fink, Colin

AU - Fitchett, Elizabeth JA

AU - Gerada, Alessandro

AU - Graves, Stephen R.

AU - Handley, Becca L.

AU - Hutchison, Coll D.

AU - Jaksuwan, Risara

AU - Jervis, Jessica

AU - Jones, Jayne

AU - Khounpaseuth, Khamxeng

AU - Kranzer, Katharina

AU - Kunlaya, Khamfong

AU - Lal, Pankaj

AU - Lubell, Yoel

AU - Mabey, David CW

AU - MacPherson, Eleanor

AU - Makoga, Forget

AU - Manichan, Sengchanh

AU - Marlais, Tegwen

AU - Maurer, Florian

AU - Mayxay, Mayfong

AU - Miles, Michael

AU - Mogeni, Polycarp

AU - Mucasse, Campos

AU - Newton, Paul N.

AU - Nguyen, Chelsea

AU - Phimolsarnnousith, Vilayouth

AU - Picardeau, Mathieu

AU - Sengduangphachanh, Amphone

AU - Sengsavang, Siho

AU - Sibanda, Molly

AU - Singha, Somvai

AU - Stenos, John

AU - Tanganuchitcharnchai, Ampai

AU - Tanvir, Hira

AU - Ussher, James E.

AU - Valente, Marta

AU - Voice, Marie A.

AU - Vongsouvath, Manivanh

AU - Wamaka, Msopole

AU - Wheat, L. Joseph

AU - Yeung, Shunmay

PY - 2024/11/1

Y1 - 2024/11/1

N2 - BackgroundClinical 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.MethodsWe 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).FindingsA 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).InterpretationWe 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.

AB - BackgroundClinical 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.MethodsWe 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).FindingsA 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).InterpretationWe 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.

KW - Area under the curve

KW - Fever

KW - MEWS

KW - Mortality

KW - Prognostic scores

KW - qSOFA

KW - Severity scores

KW - UVA

U2 - 10.1016/j.eclinm.2024.102856

DO - 10.1016/j.eclinm.2024.102856

M3 - Article

SN - 2589-5370

VL - 77

SP - e102856

JO - eClinicalMedicine

JF - eClinicalMedicine

M1 - 102856

ER -

Lal S, Luangraj M, Keddie SH, Ashley EA, Baerenbold O, Bassat Q et al. 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. 2024 Nov 1;77:e102856. 102856. Epub 2024 Oct 4. doi: 10.1016/j.eclinm.2024.102856