Predicting Mortality for Adolescent and Adult Patients with Fever in Resource-Limited Settings

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Public Health

Background:

• Febrile illnesses pose a significant mortality risk in sub-Saharan Africa.
• Early identification of high-risk patients is crucial for improving outcomes.
• Existing early warning scores require validation in diverse clinical settings.

Purpose of the Study:

• To evaluate the predictive performance of Modified Early Warning Score (MEWS), quick Sequential Organ Failure Assessment (qSOFA), and Integrated Management of Adolescent and Adult Illness (IMAI) criteria for in-hospital mortality in febrile patients in Tanzania.
• To identify reliable tools for risk stratification in febrile illnesses within sub-Saharan Africa.

Main Methods:

• Prospective cohort study of 419 febrile patients (≥ 10 years) in Tanzania (2007-2008).
• Evaluation of MEWS, qSOFA score (≥ 2), and IMAI emergency signs/severity criteria for predicting in-hospital mortality.
• Univariate analysis of clinical factors associated with mortality, including HIV infection and vital signs.

Main Results:

• Of 44 deaths, 70.5% were HIV-infected.
• Factors associated with mortality included HIV infection, low oxygen saturation, respiratory distress, altered consciousness, and low hemoglobin.
• The IMAI criterion 'presence of at least one emergency sign' demonstrated good diagnostic accuracy (high sensitivity, low negative likelihood ratio, wide AUC).
• qSOFA and MEWS showed poor performance in predicting fatal outcomes.

Conclusions:

• The IMAI emergency signs are a promising tool for identifying high-risk febrile patients in this Tanzanian cohort.
• MEWS and qSOFA scores were not effective predictors of in-hospital mortality in this population.
• Further research is needed to develop and validate accurate early warning scores for febrile illnesses in sub-Saharan Africa.