Predictors of ICU Mortality in Septic Patients in a Resource-Limited African Setting: A Prospective Multicenter Cohort Study in Lubumbashi, DRC

Predictors of ICU Mortality in Septic Patients in a Resource-Limited African Setting: A Prospective Multicenter Cohort Study in Lubumbashi, DRC | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictors of ICU Mortality in Septic Patients in a Resource-Limited African Setting: A Prospective Multicenter Cohort Study in Lubumbashi, DRC Michel Muteya Manika, Rivain Fefe Iteke, Berthe Nsimire Barhayiga, and 15 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8018664/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Sepsis remains a leading cause of intensive care unit (ICU) mortality globally, with the highest burden observed in low- and middle-income countries where diagnostic capacity, timely referral, and access to organ support are limited. However, commonly used prognostic tools rely on laboratory and monitoring resources that are often unavailable in such settings. This study aimed to identify independent predictors of ICU mortality among adults with sepsis in Lubumbashi, Democratic Republic of the Congo, and to develop a context-adapted prognostic score suitable for resource-constrained environments. Methods We conducted a prospective multicentre cohort study across three ICUs between January 2021 and April 2023. Adults meeting Sepsis-3 criteria were consecutively enrolled. Clinical status, basic laboratory parameters, therapeutic timing, and socioeconomic characteristics were recorded within 24 hours of ICU admission. Independent predictors of 28-day mortality were identified using multivariable logistic regression. A simplified point-based prognostic model (SPARS-Basique) was constructed and evaluated for discrimination (AUROC) and calibration, with internal validation using bootstrap resampling (1,000 iterations). Results A total of 136 patients were included (median age 48 years). ICU mortality was 78%, with most deaths occurring within the first five days of admission. Nine variables independently predicted mortality: age ≥ 60 years, low socioeconomic status, absence of health insurance, delay > 5 days before ICU admission, Glasgow Coma Scale ≤ 10, SpO₂ <90%, shock index ≥ 0.9, serum creatinine ≥ 3 mg/dL, and blood glucose ≥ 8 mmol/L. These variables formed the SPARS-Basique score (0–18 points). The model demonstrated strong discrimination (AUROC 0.89; bootstrap-corrected AUROC 0.87) and good calibration. Observed mortality increased across risk groups: 21% (score 0–5), 64% (6–9), and 91% (≥ 10). Conclusions Sepsis mortality in Lubumbashi ICUs is extremely high and is influenced by both biological severity and structural barriers to timely care. The SPARS-Basique score provides a pragmatic bedside tool for early risk stratification and allocation of limited critical care resources. External validation and implementation studies are required to assess its generalisability. Sepsis Critical care Mortality Prognostic score Resource-limited settings SPARS-Basique Democratic Republic of the Congo Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Dec, 2025 Reviews received at journal 15 Dec, 2025 Reviews received at journal 11 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviewers agreed at journal 29 Nov, 2025 Reviewers invited by journal 28 Nov, 2025 Editor assigned by journal 10 Nov, 2025 Submission checks completed at journal 10 Nov, 2025 First submitted to journal 03 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8018664","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":553026021,"identity":"acc29dd5-cc1f-4a3d-a2a1-038ca3730abb","order_by":0,"name":"Michel Muteya 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DRC","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-anesthesia-analgesia-and-critical-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Anesthesia, Analgesia and Critical Care](https://janesthanalgcritcare.biomedcentral.com/)","snPcode":"44158","submissionUrl":"https://submission.nature.com/new-submission/44158/3","title":"Journal of Anesthesia, Analgesia and Critical Care","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sepsis, Critical care, Mortality, Prognostic score, Resource-limited settings, SPARS-Basique, Democratic Republic of the Congo","lastPublishedDoi":"10.21203/rs.3.rs-8018664/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8018664/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSepsis remains a leading cause of intensive care unit (ICU) mortality globally, with the highest burden observed in low- and middle-income countries where diagnostic capacity, timely referral, and access to organ support are limited. However, commonly used prognostic tools rely on laboratory and monitoring resources that are often unavailable in such settings. This study aimed to identify independent predictors of ICU mortality among adults with sepsis in Lubumbashi, Democratic Republic of the Congo, and to develop a context-adapted prognostic score suitable for resource-constrained environments.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a prospective multicentre cohort study across three ICUs between January 2021 and April 2023. Adults meeting Sepsis-3 criteria were consecutively enrolled. Clinical status, basic laboratory parameters, therapeutic timing, and socioeconomic characteristics were recorded within 24 hours of ICU admission. Independent predictors of 28-day mortality were identified using multivariable logistic regression. A simplified point-based prognostic model (SPARS-Basique) was constructed and evaluated for discrimination (AUROC) and calibration, with internal validation using bootstrap resampling (1,000 iterations).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 136 patients were included (median age 48 years). ICU mortality was 78%, with most deaths occurring within the first five days of admission. Nine variables independently predicted mortality: age\u0026thinsp;\u0026ge;\u0026thinsp;60 years, low socioeconomic status, absence of health insurance, delay\u0026thinsp;\u0026gt;\u0026thinsp;5 days before ICU admission, Glasgow Coma Scale\u0026thinsp;\u0026le;\u0026thinsp;10, SpO₂ \u0026lt;90%, shock index\u0026thinsp;\u0026ge;\u0026thinsp;0.9, serum creatinine\u0026thinsp;\u0026ge;\u0026thinsp;3 mg/dL, and blood glucose\u0026thinsp;\u0026ge;\u0026thinsp;8 mmol/L. These variables formed the SPARS-Basique score (0\u0026ndash;18 points). The model demonstrated strong discrimination (AUROC 0.89; bootstrap-corrected AUROC 0.87) and good calibration. Observed mortality increased across risk groups: 21% (score 0\u0026ndash;5), 64% (6\u0026ndash;9), and 91% (\u0026ge;\u0026thinsp;10).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eSepsis mortality in Lubumbashi ICUs is extremely high and is influenced by both biological severity and structural barriers to timely care. The SPARS-Basique score provides a pragmatic bedside tool for early risk stratification and allocation of limited critical care resources. External validation and implementation studies are required to assess its generalisability.\u003c/p\u003e","manuscriptTitle":"Predictors of ICU Mortality in Septic Patients in a Resource-Limited African Setting: A Prospective Multicenter Cohort Study in Lubumbashi, DRC","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 23:13:05","doi":"10.21203/rs.3.rs-8018664/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-16T15:55:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-15T07:23:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T14:46:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202746583106950609853532036880109910237","date":"2025-12-01T09:32:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316111086038585486310782630193371939603","date":"2025-11-29T05:11:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-28T14:23:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-10T13:51:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-10T13:50:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Anesthesia, Analgesia and Critical Care","date":"2025-11-03T11:30:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-anesthesia-analgesia-and-critical-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Anesthesia, Analgesia and Critical Care](https://janesthanalgcritcare.biomedcentral.com/)","snPcode":"44158","submissionUrl":"https://submission.nature.com/new-submission/44158/3","title":"Journal of Anesthesia, Analgesia and Critical Care","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb04ee48-5f43-4713-b446-10112241276b","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-27T05:53:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 23:13:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8018664","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8018664","identity":"rs-8018664","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}