Associations between Organ Dysfunction Scoring Systems and Dysregulated Host Responses in Adults with Severe Infection in Uganda: A Prospective Cohort Study
Scoring systems for organ dysfunction (e.g., the quick Sepsis-related Organ Failure Assessment [qSOFA], Modified Early Warning Score [MEWS], and Universal Vital Assessment [UVA]) are proposed as clinical criteria for sepsis. The content validity of these scoring systems is poorly understood in sub-S...
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| Veröffentlicht in: | The American journal of tropical medicine and hygiene Jg. 113; H. 1; S. 214 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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United States
01.07.2025
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| ISSN: | 1476-1645, 1476-1645 |
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| Abstract | Scoring systems for organ dysfunction (e.g., the quick Sepsis-related Organ Failure Assessment [qSOFA], Modified Early Warning Score [MEWS], and Universal Vital Assessment [UVA]) are proposed as clinical criteria for sepsis. The content validity of these scoring systems is poorly understood in sub-Saharan Africa, where the global sepsis burden is concentrated. In a prospective cohort of 288 adults hospitalized with suspected sepsis in Uganda, we show that qSOFA, MEWS, and UVA scores were significantly associated with soluble mediators of innate and adaptive immune activation, endothelial dysfunction, and fibrinolysis. Results were consistent after adjustment for demographics, illness duration, and HIV or malaria coinfection. In resource-limited settings in sub-Saharan Africa, organ dysfunction scores may stratify patients at highest risk of poor outcomes and those with more dysregulated host responses. Further studies are needed to better define these relationships, including the temporal dynamics of dysregulated host responses and organ dysfunction in sepsis. |
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| AbstractList | Scoring systems for organ dysfunction (e.g., the quick Sepsis-related Organ Failure Assessment [qSOFA], Modified Early Warning Score [MEWS], and Universal Vital Assessment [UVA]) are proposed as clinical criteria for sepsis. The content validity of these scoring systems is poorly understood in sub-Saharan Africa, where the global sepsis burden is concentrated. In a prospective cohort of 288 adults hospitalized with suspected sepsis in Uganda, we show that qSOFA, MEWS, and UVA scores were significantly associated with soluble mediators of innate and adaptive immune activation, endothelial dysfunction, and fibrinolysis. Results were consistent after adjustment for demographics, illness duration, and HIV or malaria coinfection. In resource-limited settings in sub-Saharan Africa, organ dysfunction scores may stratify patients at highest risk of poor outcomes and those with more dysregulated host responses. Further studies are needed to better define these relationships, including the temporal dynamics of dysregulated host responses and organ dysfunction in sepsis. Scoring systems for organ dysfunction (e.g., the quick Sepsis-related Organ Failure Assessment [qSOFA], Modified Early Warning Score [MEWS], and Universal Vital Assessment [UVA]) are proposed as clinical criteria for sepsis. The content validity of these scoring systems is poorly understood in sub-Saharan Africa, where the global sepsis burden is concentrated. In a prospective cohort of 288 adults hospitalized with suspected sepsis in Uganda, we show that qSOFA, MEWS, and UVA scores were significantly associated with soluble mediators of innate and adaptive immune activation, endothelial dysfunction, and fibrinolysis. Results were consistent after adjustment for demographics, illness duration, and HIV or malaria coinfection. In resource-limited settings in sub-Saharan Africa, organ dysfunction scores may stratify patients at highest risk of poor outcomes and those with more dysregulated host responses. Further studies are needed to better define these relationships, including the temporal dynamics of dysregulated host responses and organ dysfunction in sepsis.Scoring systems for organ dysfunction (e.g., the quick Sepsis-related Organ Failure Assessment [qSOFA], Modified Early Warning Score [MEWS], and Universal Vital Assessment [UVA]) are proposed as clinical criteria for sepsis. The content validity of these scoring systems is poorly understood in sub-Saharan Africa, where the global sepsis burden is concentrated. In a prospective cohort of 288 adults hospitalized with suspected sepsis in Uganda, we show that qSOFA, MEWS, and UVA scores were significantly associated with soluble mediators of innate and adaptive immune activation, endothelial dysfunction, and fibrinolysis. Results were consistent after adjustment for demographics, illness duration, and HIV or malaria coinfection. In resource-limited settings in sub-Saharan Africa, organ dysfunction scores may stratify patients at highest risk of poor outcomes and those with more dysregulated host responses. Further studies are needed to better define these relationships, including the temporal dynamics of dysregulated host responses and organ dysfunction in sepsis. |
| Author | Lipkin, W Ian Owor, Nicholas Byaruhanga, Timothy Che, Xiaoyu Namulondo, Joyce Tiao, Jonathan Nsereko, Christopher Cummings, Matthew J Muwanga, Moses Kayiwa, John O'Donnell, Max R Nayiga, Irene Lutwama, Julius J Bakamutumaho, Barnabas |
| Author_xml | – sequence: 1 givenname: Jonathan surname: Tiao fullname: Tiao, Jonathan organization: Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York – sequence: 2 givenname: Barnabas surname: Bakamutumaho fullname: Bakamutumaho, Barnabas organization: Immunizable Diseases Unit, Uganda Virus Research Institute, Entebbe, Uganda – sequence: 3 givenname: Nicholas surname: Owor fullname: Owor, Nicholas organization: Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda – sequence: 4 givenname: John surname: Kayiwa fullname: Kayiwa, John organization: Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda – sequence: 5 givenname: Joyce surname: Namulondo fullname: Namulondo, Joyce organization: Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda – sequence: 6 givenname: Timothy surname: Byaruhanga fullname: Byaruhanga, Timothy organization: Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda – sequence: 7 givenname: Moses surname: Muwanga fullname: Muwanga, Moses organization: Entebbe General Referral Hospital, Ministry of Health, Entebbe, Uganda – sequence: 8 givenname: Christopher surname: Nsereko fullname: Nsereko, Christopher organization: Entebbe General Referral Hospital, Ministry of Health, Entebbe, Uganda – sequence: 9 givenname: Irene surname: Nayiga fullname: Nayiga, Irene organization: Entebbe General Referral Hospital, Ministry of Health, Entebbe, Uganda – sequence: 10 givenname: Xiaoyu surname: Che fullname: Che, Xiaoyu organization: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York – sequence: 11 givenname: W Ian surname: Lipkin fullname: Lipkin, W Ian organization: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York – sequence: 12 givenname: Julius J surname: Lutwama fullname: Lutwama, Julius J organization: Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda – sequence: 13 givenname: Max R surname: O'Donnell fullname: O'Donnell, Max R organization: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York – sequence: 14 givenname: Matthew J surname: Cummings fullname: Cummings, Matthew J organization: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York |
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| SubjectTerms | Adult Female HIV Infections - complications Humans Malaria - complications Male Middle Aged Multiple Organ Failure Organ Dysfunction Scores Prospective Studies Sepsis - diagnosis Sepsis - epidemiology Sepsis - immunology Uganda - epidemiology |
| Title | Associations between Organ Dysfunction Scoring Systems and Dysregulated Host Responses in Adults with Severe Infection in Uganda: A Prospective Cohort Study |
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