University of Melbourne, School of Population and Global Health, Melbourne, Australia.
Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, United States of America.
PLoS One. 2022 Mar 23;17(3):e0265713. doi: 10.1371/journal.pone.0265713. eCollection 2022.
We previously derived a Universal Vital Assessment (UVA) score to better risk-stratify hospitalized patients in sub-Saharan Africa, including those with infection. Here, we aimed to externally validate the performance of the UVA score using previously collected data from patients hospitalized with acute infection in Rwanda.
We performed a secondary analysis of data collected from adults ≥18 years with acute infection admitted to Gitwe District Hospital in Rwanda from 2016 until 2017. We calculated the UVA score from the time of admission and at 72 hours after admission. We also calculated quick sepsis-related organ failure assessment (qSOFA) and modified early warning scores (MEWS). We calculated amalgamated qSOFA scores by inserting UVA cut-offs into the qSOFA score, and modified UVA scores by removing the HIV criterion. The performance of each score determined by the area under the receiver operator characteristic curve (AUC) was the primary outcome measure.
We included 573 hospitalized adult patients with acute infection of whom 40 (7%) died in-hospital. The admission AUCs (95% confidence interval [CI]) for the prediction of mortality by the scores were: UVA, 0.77 (0.68-0.85); modified UVA, 0.77 (0.68-0.85); qSOFA, 0.66 (0.56-0.75), amalgamated qSOFA, 0.71 (0.61-0.80); and MEWS, 0.74 (0.64, 0.83). The positive predictive values (95% CI) of the scores at commonly used cut-offs were: UVA >4, 0.35 (0.15-0.59); modified UVA >4, 0.35 (0.15-0.59); qSOFA >1, 0.14 (0.07-0.24); amalgamated qSOFA >1, 0.44 (0.20-0.70); and MEWS >5, 0.14 (0.08-0.22). The 72 hour (N = 236) AUC (95% CI) for the prediction of mortality by UVA was 0.59 (0.43-0.74). The Chi-Square test for linear trend did not identify an association between mortality and delta UVA score at 72 hours (p = 0.82).
The admission UVA score and amalgamated qSOFA score had good predictive ability for mortality in adult patients admitted to hospital with acute infection in Rwanda. The UVA score could be used to assist with triage decisions and clinical interventions, for baseline risk stratification in clinical studies, and in a clinical definition of sepsis in Africa.
我们之前推导出了一个通用生命评估（UVA）评分，以便更好地对撒哈拉以南非洲的住院患者进行风险分层，包括感染患者。在此，我们旨在使用之前从卢旺达急性感染住院患者中收集的数据来验证 UVA 评分的外部表现。
我们对 2016 年至 2017 年期间从卢旺达吉特韦区医院入院的 18 岁及以上成人急性感染患者的数据进行了二次分析。我们在入院时和入院后 72 小时计算 UVA 评分。我们还计算了快速序贯器官衰竭评估（qSOFA）和改良早期预警评分（MEWS）。我们通过将 UVA 切点插入 qSOFA 评分来计算合并 qSOFA 评分，并通过删除 HIV 标准来计算改良 UVA 评分。每个评分通过接收者操作特征曲线下面积（AUC）来确定的表现是主要的测量结果。
我们纳入了 573 名患有急性感染的住院成年患者，其中 40 名（7%）在院内死亡。评分对死亡率的预测的入院 AUC（95%置信区间[CI]）为：UVA，0.77（0.68-0.85）；改良 UVA，0.77（0.68-0.85）；qSOFA，0.66（0.56-0.75），合并 qSOFA，0.71（0.61-0.80）；MEWS，0.74（0.64，0.83）。评分在常用切点的阳性预测值（95%CI）为：UVA>4，0.35（0.15-0.59）；改良 UVA>4，0.35（0.15-0.59）；qSOFA>1，0.14（0.07-0.24）；合并 qSOFA>1，0.44（0.20-0.70）；MEWS>5，0.14（0.08-0.22）。UVA 对 72 小时死亡率的预测的 72 小时 AUC（95%CI）为 0.59（0.43-0.74）。72 小时 UVA 评分的线性趋势卡方检验未发现死亡率与 UVA 评分变化之间存在关联（p=0.82）。
在卢旺达急性感染住院患者中，入院时的 UVA 评分和合并 qSOFA 评分对死亡率具有良好的预测能力。UVA 评分可用于辅助分诊决策和临床干预，用于临床研究中的基线风险分层，以及非洲脓毒症的临床定义。
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