ArticleBMJ open2023
Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Sepsis screening tools in resource-limited settings: a systematic review and meta-analysis of diagnostic accuracy in low- and middle-income countries.Frontiers in public health · 2026Pooled it
- Likelihood of Blood Culture Positivity Using SeptiCyte RAPID.Journal of clinical medicine · 2026Article
- Adapting a commercial sample extraction protocol for biosafety level 3/4 compatible plasma metabolomics analysis.Journal of mass spectrometry and advances in the clinical lab · 2025Article
- Risk Factors and Development of a Predictive Model for In-Hospital Mortality in Hemodynamically Stable Older Adults with Urinary Tract Infection.Medicina (Kaunas, Lithuania) · 2025Article
- Likelihood of blood culture positivity using SeptiCyte RAPID.medRxiv : the preprint server for health sciences · 2025Article
- Global emergency medicine: A scoping review of the literature from 2023.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Article
- Molecular epidemiology of Escherichia coli in bloodstream infections from a general hospital in Ningxia, China, 2022-2023.BMC infectious diseases · 2025Article
- Sepsis endotypes identified by host gene expression across global cohorts.Communications medicine · 2024Article
- Gene expression signatures in blood from a West African sepsis cohort define host response phenotypes.Nature communications · 2024Article
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Authors and funding
31 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesWe evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana.
designProspective cohort studies. SETTING AND
participantsFrom 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome) criteria and suspected infection were enrolled in emergency departments and medical wards at hospitals in Cambodia and Ghana and hospitalised participants with suspected infection were enrolled in the USA. Cox proportional hazards regression was performed, and Harrell's C-statistic calculated to determine 28-day mortality prediction performance of the quick Sequential Organ Failure Assessment (qSOFA) score ≥2, SIRS score ≥3, National Early Warning Score (NEWS) ≥5, Modified Early Warning Score (MEWS) ≥5 or Universal Vital Assessment (UVA) score ≥2. Screening tools were compared with baseline risk (age and sex) with the Wald test.
resultsThe cohorts included 567 participants (42.9% women) including 187 participants from Kumasi, Ghana, 200 participants from Takeo, Cambodia and 180 participants from Durham, North Carolina in the USA. The pooled mortality was 16.4% at 28 days. The mortality prediction accuracy increased from baseline risk with the MEWS (C-statistic: 0.63, 95% CI 0.58 to 0.68; p=0.002), NEWS (C-statistic: 0.68; 95% CI 0.64 to 0.73; p<0.001), qSOFA (C-statistic: 0.70, 95% CI 0.64 to 0.75; p<0.001), UVA score (C-statistic: 0.73, 95% CI 0.69 to 0.78; p<0.001), but not with SIRS (0.60; 95% CI 0.54 to 0.65; p=0.13). Within individual cohorts, only the UVA score in Ghana performed better than baseline risk (C-statistic: 0.77; 95% CI 0.71 to 0.83; p<0.001).
conclusionsAmong the cohorts, MEWS, NEWS, qSOFA and UVA scores performed better than baseline risk, largely driven by accuracy improvements in Ghana, while SIRS scores did not improve prognostication accuracy. Prognostication scores should be validated within the target population prior to clinical use.
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