ArticlemedRxiv : the preprint server for health sciences2026
Assessment of Bedside-Adaptable Models to Predict Molecular Sepsis Subtypes in a Resource-Limited Setting: A Multicenter Analysis from Uganda.
Article in medRxiv : the preprint server for health sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Biologically defined sepsis subtypes have been identified in low- and middle-income countries (LMICs), but limited access to molecular diagnostics challenges broader evaluation and implementation in resource-limited settings. We assessed whether models including bedside clinical and rapid microbiologic data could accurately stratify Ugandan adults with sepsis by molecular subtype. Design: Secondary analysis of two prospective observational sepsis cohorts, testing bedside-adaptable classifier models against transcriptomic and proteomic subtype assignments. Setting: Entebbe Regional Referral Hospital (urban) and Tororo General Hospital (rural), Uganda. Patients: Adults (≥18 years) hospitalized with sepsis, with available transcriptomic (N=355) and/or proteomic (N=495) profiling enabling subtype assignment. Interventions: None. Measurements and Main Results: Using data from two prospective cohorts (RESERVE-U-2-TOR and RESERVE-U-1-EBB), we evaluated bedside-adaptable models against Uganda-derived molecular sepsis subtypes, and, secondarily, against molecular subtypes and axes derived in high-income countries. In RESERVE-U-2-TOR, clinical models including demographics and bedside physiological variables demonstrated moderate discrimination for transcriptomic and proteomic subtype assignment (AUROC 0.75 [95% CI, 0.69-0.81] and 0.73 [0.66-0.80], respectively) with strong calibration (Integrated Calibration Index [E Conclusions: Bedside-adaptable clinical models, with or without rapid microbiologic testing, demonstrated acceptable calibration but only modest discrimination for molecular sepsis subtype assignment in Uganda. Expanding laboratory capacity and access to scalable, low-cost molecular biomarker assays will be necessary to advance precision sepsis care in LMIC settings.
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