A Karnofsky Performance Status-Based Risk Score Improves Prediction of Post-Sepsis Mortality in Sub-Saharan Africa: A Multicohort Study From Uganda.

Abstract

Sepsis survivors worldwide face a high risk of death after hospitalization. In sub-Saharan Africa, where nearly 40% of all sepsis cases occur, post-discharge mortality is a major contributor to poor sepsis outcomes. In this context, stratification of sepsis survivors at high risk for post-discharge mortality is needed to guide targeted follow-up care. We sought to determine the performance of Karnofsky Performance Status (KPS)-based risk stratification for predicting post-discharge mortality among adults surviving sepsis hospitalization in Uganda. Analysis of two prospective observational cohorts in Uganda. Two public hospitals in Entebbe and Tororo, Uganda. Adults (≥ 18 yr) hospitalized with sepsis, defined by signs of infection and quick Sepsis-related Organ Failure Assessment score greater than or equal to 1, who were discharged or transferred alive from the hospital. None. KPS was assessed on the day of discharge or transfer by study clinicians. Vital status was ascertained at 30 and 60 days post-discharge in the Entebbe ( n = 217) and Tororo ( n = 251) cohorts, respectively. In both cohorts, higher KPS scores at discharge or transfer were significantly associated with reduced odds of post-discharge mortality after adjustment for demographics, inpatient physiologic severity, high-burden co-infections and duration of hospitalization (adjusted odds ratios, 0.95 [95% CI, 0.93-0.98] and 0.96 [95% CI, 0.94-0.98] in Entebbe and Tororo, respectively). Adding KPS to a baseline risk model including the above variables significantly improved post-discharge mortality prediction in both cohorts; predictive discrimination and calibration were also improved. KPS assessed at hospital discharge significantly improves prediction of post-discharge mortality among acute sepsis survivors in sub-Saharan Africa. Incorporating KPS into discharge planning may help guide targeted interventions to improve sepsis survivorship in low- and middle-income countries.