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

OBJECTIVES: 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. DESIGN: Analysis of two prospective observational cohorts in Uganda. SETTING: Two public hospitals in Entebbe and Tororo, Uganda. PATIENTS: 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. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.