Sepsis burden and mortality prediction using quick sequential organ failure assessment score among medical emergency ward patients at Mulago Hospital

Abstract

Introduction: Sepsis, currently defined as life threatening organ dysfunction due to dysregulated host response to infection can result from any infection with bacteria causing majority of cases. It is estimated that 31 million cases occur annually causing about 6 million deaths globally. Data about sepsis burden is derived almost exclusively from studies in high income countries (HICs) yet mortality from sepsis is disproportionately higher in low- and middle-income countries (LMICs). The 2016 SSC guidelines recommended use of Quick Sequential Organ Failure Assessment (QSOFA) score for risk prognosticating patients with sepsis but this tool is yet to be validated in most LMICs including Uganda. General objective: The overall objective was to determine the prevalence of sepsis, in-hospital outcomes and assess the performance of qSOFA score in predicting mortality among septic patients admitted to the medical emergency ward of Mulago hospital. Methodology: This was a prospective observational single cohort study in which patients presenting to the medical emergency ward between 27th December 2018 and 27th July 2019 were consecutively screened for presence of sepsis. Patients with sepsis were then followed up to determine their in-hospital outcomes. Aerobic blood cultures were performed and antimicrobial susceptibility patterns determined. Results: Between 27th Dec, 2018 and 27th July, 2019, 1657 patients were admitted while a study team member was present. Of these patients, 243(14.7%) fulfilled the study criteria for sepsis and were enrolled. Of the 243 patients, 143(58.9%) died in hospital, none was admitted in ICU and a qSOFA score of ≥2 had a sensitivity of 67.1% and a specificity of 44.0% in predicting in-hospital mortality. Forty-six patients had positive aerobic blood cultures and Staphylococcus aureus was the most common isolate (n=31) with a predominance of Methicillin Resistant Staphylococcus aureus (MRSA) (20 isolates). Conclusion: Sepsis was a common condition among the medical emergency ward patients and it was associated with a high in-hospital mortality rate. The qSOFA score was poor in predicting in-hospital mortality among patients with sepsis. Antimicrobial resistant bacteria were highly prevalent such as Methicillin Resistant S. aureus (43.4% of all isolates).