دورية أكاديمية
Association of clinical prediction scores with hospital mortality in an adult medical and surgical intensive care unit in Kenya.
| العنوان: | Association of clinical prediction scores with hospital mortality in an adult medical and surgical intensive care unit in Kenya. |
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| المؤلفون: | Brotherton BJ; Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya.; The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States., Joshi M; Department of Medicine, Stanford University, Palo Alto, CA, United States., Otieno G; Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya., Wandia S; Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya., Gitura H; Department of Emergency and Critical Care Medicine, AIC Kijabe Hospital, Kijabe, Kenya., Mueller A; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States., Nguyen T; Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya., Letchford S; Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya., Riviello ED; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States., Karanja E; Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya., Rudd KE; The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States. |
| المصدر: | Frontiers in medicine [Front Med (Lausanne)] 2023 Apr 05; Vol. 10, pp. 1127672. Date of Electronic Publication: 2023 Apr 05 (Print Publication: 2023). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Frontiers Media S.A Country of Publication: Switzerland NLM ID: 101648047 Publication Model: eCollection Cited Medium: Print ISSN: 2296-858X (Print) Linking ISSN: 2296858X NLM ISO Abbreviation: Front Med (Lausanne) Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: Lausanne, Switzerland : Frontiers Media S.A., [2014]- |
| مستخلص: | Importance: Mortality prediction among critically ill patients in resource limited settings is difficult. Identifying the best mortality prediction tool is important for counseling patients and families, benchmarking quality improvement efforts, and defining severity of illness for clinical research studies. Objective: Compare predictive capacity of the Modified Early Warning Score (MEWS), Universal Vital Assessment (UVA), Tropical Intensive Care Score (TropICS), Rwanda Mortality Probability Model (R-MPM), and quick Sequential Organ Failure Assessment (qSOFA) for hospital mortality among adults admitted to a medical-surgical intensive care unit (ICU) in rural Kenya. We performed a pre-planned subgroup analysis among ICU patients with suspected infection. Design Setting and Participants: Prospective single-center cohort study at a tertiary care, academic hospital in Kenya. All adults 18 years and older admitted to the ICU January 2018-June 2019 were included. Main Outcomes and Measures: The primary outcome was association of clinical prediction tool score with hospital mortality, as defined by area under the receiver operating characteristic curve (AUROC). Demographic, physiologic, laboratory, therapeutic, and mortality data were collected. 338 patients were included, none were excluded. Median age was 42 years (IQR 33-62) and 61% ( n = 207) were male. Fifty-nine percent ( n = 199) required mechanical ventilation and 35% ( n = 118) received vasopressors upon ICU admission. Overall hospital mortality was 31% ( n = 104). 323 patients had all component variables recorded for R-MPM, 261 for MEWS, and 253 for UVA. The AUROC was highest for MEWS (0.76), followed by R-MPM (0.75), qSOFA (0.70), and UVA (0.69) ( p < 0.001). Predictive capacity was similar among patients with suspected infection. Conclusion and Relevance: All tools had acceptable predictive capacity for hospital mortality, with variable observed availability of the component data. R-MPM and MEWS had high rates of variable availability as well as good AUROC, suggesting these tools may prove useful in low resource ICUs. Competing Interests: KR reports consulting fees from Janssen Pharmaceuticals. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Brotherton, Joshi, Otieno, Wandia, Gitura, Mueller, Nguyen, Letchford, Riviello, Karanja and Rudd.) |
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| معلومات مُعتمدة: | K23 GM141463 United States GM NIGMS NIH HHS |
| فهرسة مساهمة: | Keywords: Kenya; critical care; global health; mortality prediction; resource variable; severity of illness |
| تواريخ الأحداث: | Date Created: 20230424 Latest Revision: 20230608 |
| رمز التحديث: | 20230608 |
| مُعرف محوري في PubMed: | PMC10113620 |
| DOI: | 10.3389/fmed.2023.1127672 |
| PMID: | 37089585 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2296-858X |
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| DOI: | 10.3389/fmed.2023.1127672 |