Context-specific predictors of mortality and the performance of paediatric sepsis scores in Tanzanian children: a secondary analysis of a prospective cohort study

Abstract

INTRODUCTION: Sepsis is a significant cause of global child mortality, disproportionately affecting resource-limited settings (RLS). Although clinical scores have been proposed in RLS, few have been externally validated. This study aimed to identify risk factors for mortality among Tanzanian children with sepsis and test three paediatric clinical scores in an RLS. METHODS: We conducted a secondary analysis of a prospective cohort study of 755 children (28 days to 14 years) with sepsis in the Emergency Department at Muhimbili National Hospital, Tanzania (July 2022-November 2024). Demographic, clinical and outcome data were collected. We performed multivariable logistic regression to identify independent predictors of in-hospital mortality. We then tested three clinical scores, Lambaréné Organ Dysfunction Score (LODS), Blantyre quick Sequential Organ Failure Assessment (BqSOFA) and Phoenix Sepsis Score (PSS), using sensitivity, specificity and area under the receiver operating characteristic curve (AUC). RESULTS: In-hospital mortality was 20% (n=148); independent predictors included age, malnutrition, HIV status, referral status and delayed presentation (p<0.001). All three scores demonstrated strong discrimination for mortality (LODS AUC 0.79, 95% CI 0.75 to 0.83; BqSOFA AUC 0.75, 95% CI 0.71 to 0.79; PSS AUC 0.75, 95% CI 0.70 to 0.79) and differences between scores were not statistically significant (p=0.066). LODS showed high sensitivity (93%) and negative predictive value (96%). BqSOFA and PSS demonstrated high specificity (93% and 91%) and positive predictive values (51% and 56%), but low sensitivity (28% and 44%). CONCLUSIONS: Multiple clinical and sociodemographic factors were independently associated with mortality in children with sepsis. LODS demonstrated high sensitivity, while BqSOFA and PSS demonstrated high specificity; the scores' discriminative ability for mortality was not statistically significant. The identification of simple risk factors and moderately performing clinical scores provides a valuable opportunity to develop context-specific risk stratification tools for paediatric sepsis in RLS.