Prediction models for post-discharge mortality among under-five children with suspected sepsis in Uganda: A multicohort analysis.

Autor:	Wiens MO; Institute for Global Health at BC Children's and Women's Hospital, Vancouver, Canada.; Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada.; BC Children's Hospital Research Institute, Vancouver, Canada.; Walimu, Kampala, Uganda., Nguyen V; Institute for Global Health at BC Children's and Women's Hospital, Vancouver, Canada., Bone JN; BC Children's Hospital Research Institute, Vancouver, Canada., Kumbakumba E; Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda., Businge S; Holy Innocents Children's Hospital, Mbarara, Uganda., Tagoola A; Jinja Regional Referral Hospital, Jinja City, Uganda., Sherine SO; Masaka Regional Referral Hospital, Masaka, Uganda., Byaruhanga E; Kawempe National Referral Hospital, Kampala, Uganda., Ssemwanga E; Villa Maria Hospital, Masaka, Uganda., Barigye C; Mbarara Regional Referral Hospital, Mbarara, Uganda., Nsungwa J; Ministry of Health for the Republic of Uganda, Kampala, Uganda., Olaro C; Ministry of Health for the Republic of Uganda, Kampala, Uganda., Ansermino JM; Institute for Global Health at BC Children's and Women's Hospital, Vancouver, Canada.; Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada.; BC Children's Hospital Research Institute, Vancouver, Canada., Kissoon N; BC Children's Hospital Research Institute, Vancouver, Canada.; Department of Pediatrics, University of British Columbia, Vancouver, Canada., Singer J; School of Population and Public Health, University of British Columbia, Vancouver, Canada., Larson CP; School of Population and Global Health, McGill University, Montréal, Canada., Lavoie PM; BC Children's Hospital Research Institute, Vancouver, Canada.; Department of Pediatrics, University of British Columbia, Vancouver, Canada., Dunsmuir D; Institute for Global Health at BC Children's and Women's Hospital, Vancouver, Canada.; BC Children's Hospital Research Institute, Vancouver, Canada., Moschovis PP; Division of Global Health, Massachusetts General Hospital, Boston, MA, United States of America., Novakowski S; Institute for Global Health at BC Children's and Women's Hospital, Vancouver, Canada.; Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada., Komugisha C; Walimu, Kampala, Uganda., Tayebwa M; Walimu, Kampala, Uganda., Mwesigwa D; Walimu, Kampala, Uganda., Knappett M; Institute for Global Health at BC Children's and Women's Hospital, Vancouver, Canada., West N; BC Children's Hospital Research Institute, Vancouver, Canada., Mugisha NK; Walimu, Kampala, Uganda., Kabakyenga J; Maternal Newborn & Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.; Faculty of Medicine, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Apr 29; Vol. 4 (4), pp. e0003050. Date of Electronic Publication: 2024 Apr 29 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0003050
Abstrakt:	In many low-income countries, over five percent of hospitalized children die following hospital discharge. The lack of available tools to identify those at risk of post-discharge mortality has limited the ability to make progress towards improving outcomes. We aimed to develop algorithms designed to predict post-discharge mortality among children admitted with suspected sepsis. Four prospective cohort studies of children in two age groups (0-6 and 6-60 months) were conducted between 2012-2021 in six Ugandan hospitals. Prediction models were derived for six-months post-discharge mortality, based on candidate predictors collected at admission, each with a maximum of eight variables, and internally validated using 10-fold cross-validation. 8,810 children were enrolled: 470 (5.3%) died in hospital; 257 (7.7%) and 233 (4.8%) post-discharge deaths occurred in the 0-6-month and 6-60-month age groups, respectively. The primary models had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95%CI 0.74-0.80) for 0-6-month-olds and 0.75 (95%CI 0.72-0.79) for 6-60-month-olds; mean AUROCs among the 10 cross-validation folds were 0.75 and 0.73, respectively. Calibration across risk strata was good: Brier scores were 0.07 and 0.04, respectively. The most important variables included anthropometry and oxygen saturation. Additional variables included: illness duration, jaundice-age interaction, and a bulging fontanelle among 0-6-month-olds; and prior admissions, coma score, temperature, age-respiratory rate interaction, and HIV status among 6-60-month-olds. Simple prediction models at admission with suspected sepsis can identify children at risk of post-discharge mortality. Further external validation is recommended for different contexts. Models can be digitally integrated into existing processes to improve peri-discharge care as children transition from the hospital to the community. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2024 Wiens et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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