Frequency, Characteristics, Risk Factors, and Outcomes Among Patients with Sepsis in the Emergency Department: A Single-Centre Prospective Study in Somalia

Frequency, Characteristics, Risk Factors, and Outcomes Among Patients with Sepsis in the Emergency Department: A Single-Centre Prospective Study in Somalia | 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 Frequency, Characteristics, Risk Factors, and Outcomes Among Patients with Sepsis in the Emergency Department: A Single-Centre Prospective Study in Somalia Abdullahi Ahmed Ahmed, Abdishakur Mohamed Abdirahman, Mohamed Adan Hassan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7852067/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Sepsis is a serious condition associated with significant morbidity and death, especially in resource-limited settings. In Somalia, data on the incidence, clinical features, and outcomes of sepsis is limited. This study sought to delineate the prevalence, risk factors, and outcomes of sepsis in patients admitted to a tertiary hospital emergency department. Methods A prospective descriptive study was performed at the Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital from June 2024 to February 2025. Individuals of all ages with suspected or confirmed sepsis, as defined by Sepsis-3 criteria, were included. Demographic data, comorbidities, clinical presentations, laboratory results, management strategies, and in-hospital outcomes were gathered and analyzed by descriptive and inferential statistics. Results A total of 169 patients were enrolled (mean age 45.6 years; 58% male). The predominant causes of infection were soft tissue (26%), pulmonary (21.9%), and urinary tract infections (16.6%). Comorbidities were observed in 49.1% of patients, with diabetes (20.7%) and hypertension (15.4%) being the most prevalent. Clinical observations comprised fever (79%), tachycardia (82.8%), hypotension (36.1%), hypoxia (40.2%), and altered awareness (42%). Laboratory findings indicated multi-organ involvement, comprising renal impairment (43.2%), hepatic dysfunction, leukocytosis (72.8%), and increased procalcitonin levels (55.1%). The overall in-hospital death rate was 30.2%, with risk factors comprising advanced age, comorbidities, hypotension, hypoxia, and multi-organ failure. Conclusion Sepsis in Somalia is linked to significant morbidity and mortality, worsened by delayed presentation, comorbidities, and insufficient critical care resources. Enhancing early detection, timely antibiotic treatment, and increasing inpatient and ICU capacity are crucial. These findings underscore the pressing necessity for context-specific sepsis protocols and resource-appropriate care options in low-income environments. Sepsis Emergency Department Somalia Resource-Limited Settings Risk Factors Mortality Organ Dysfunction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Sepsis is a devastating global condition characterized by bodily harm owing to infections, leading to inflammatory reactions. This illness is also recognized for the rising mortality rate, particularly among patients referred to the Intensive Care Unit ( 1 ). The Global Burden of Disease Study reported 48.9 million new sepsis cases and 11 million sepsis-related deaths in 2017. Additionally, they observed that sepsis fatalities accounted for 19.7% of total global mortality throughout the examined timeframe. The most substantial impact of sepsis was observed in lower-middle-income countries (LMICs), specifically in sub-Saharan Africa, Oceania, South Asia, East Asia, and Southeast Asia ( 2 , 3 ). The patient's integument and the surrounding environment were the sources of germs responsible for SSIs. In both instances, germs may adhere to surgical instruments, potentially contaminating the incision wound, especially during unsanitary surgical practices ( 4 ). The bulk of these infections are linked to multidrug-resistant bacteria ( 5 ). Sepsis continues to be a globally life-threatening infection that significantly impairs bodily functions, leading to elevated mortality rates and multiple organ failure. It impacts millions of individuals each year, particularly in low and middle-income nations due to insufficient healthcare infrastructure and critical care resources. In affluent nations, the elderly and individuals with comorbidities are the most impacted, and there exists a well-defined epidemiology and prognosis for the disease. The results offer essential insights into local sepsis epidemiology, enhancing diagnosis and therapy in resource-constrained environments ( 1 , 6 ). This study examines Sepsis is a severe infection caused by an out-of-control immune response, leading to tissue injury, organ dysfunction, and high mortality. It is still among the leading causes of mortality and morbidity worldwide, especially in low-resource settings where critical care facilities are limited. The majority of patients in this research were aged between 41 and 60 years, and were slightly more affected in males. The source of the infections was soft tissue, respiratory, and urinary tract. Diabetes mellitus was the most common comorbidity. Fever, tachycardia, hypotension, and respiratory distress were common in clinical presentation, and laboratory findings showed multi-organ injury and elevated Procalcitonin. Methods and Materials Study Design and Setting This prospective descriptive study was conducted at the Emergency Department (ED) of the Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital (MSTH), a leading tertiary referral and teaching hospital in southern Somalia. MSTH serves as a major healthcare provider for over 2 million people, offering comprehensive emergency, medical, and critical care services, as well as teaching and research initiatives. The hospital has more than 300 beds and functions as the sole tertiary teaching institution in the region. Study Population The study included all patients presenting with sepsis to the ED of MSTH between June 2024 and February 2025. Patients of all ages and genders with suspected or confirmed sepsis were considered eligible. Sepsis was defined according to the Sepsis-3 criteria, with organ dysfunction identified by a SOFA score of 2 or greater in the presence of a suspected or confirmed infection. Exclusion criteria included: Patients with incomplete medical records or transferred out of the hospital before definitive evaluation. Data Collection Data were collected prospectively using a standardised data collection form. Trained emergency physicians recorded variables including : Demographic Information: Age, gender, comorbidities, and other relevant social factors. Clinical Presentation: Vital signs at ED arrival (temperature, heart rate, respiratory rate, blood pressure, oxygen saturation), neurological status (GCS), and severity scores (qSOFA, SOFA). Source of Infection: Classification of primary infection site (soft tissue, respiratory, urinary tract, intra-abdominal, bloodstream, device-related, CNS, surgical site). Laboratory Investigations: Complete blood count, renal and liver function tests, coagulation profile, lactate, and inflammatory markers including procalcitonin. Management and Interventions: Fluid resuscitation, vasopressor support, antibiotic therapy, mechanical ventilation, and ICU admission. Outcomes: Length of ED stay, disposition (ward, ICU, discharge, death), and in-hospital mortality. Risk Factor Assessment Potential risk factors for sepsis and poor outcomes were systematically assessed, including: Patient-related factors: Age, gender, and underlying comorbidities (diabetes, hypertension, chronic respiratory disease, cardiovascular disease). Infection-related factors: Source of infection and severity at presentation. Management-related factors: Delays in antibiotic administration or supportive therapy. Ethical Considerations Ethical approval was obtained from the Institutional Review Board (IRB) of MSTH (Approval No.: 05.08.2024 MSTH/18792). Written informed consent was obtained from all patients or their legal guardians before inclusion in the study. Patient confidentiality was strictly maintained, and all procedures were conducted in accordance with the principles outlined in the Declaration of Helsinki . Statistical Analysis Data were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarise continuous variables as means ± standard deviations or medians with interquartile ranges, and categorical variables as frequencies and percentages. Comparative analyses were conducted using chi-square tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables, as appropriate. Multivariate logistic regression was employed to identify independent risk factors for in-hospital mortality and severe sepsis. Statistical significance was set at p < 0.05. Results A total of 169 patients were enrolled in the study. The mean age was 45.6 years (range 1–91), and the largest proportion of cases occurred among adults aged 41–60 years. Males were slightly more represented than females (58.0% vs. 42.0%) ( Table 1 ). Table 1 Baseline characteristics at ED presentation Baseline characteristics at ED presentation (n = 169). n % Age (years) M = 45.6 - Gender Male 98 58 Female 71 42 Primary site of Infection Bloodstream 22 13 Device-related 6 3.6 Respiratory tract 37 21.9 Urinary tract 28 16.6 Intra-abdominal 25 14.8 CNS 4 2.4 Soft tissue 44 26 Surgical site 3 1.8 Chronic disease DM 35 20.7 DM with HTN 26 15.4 HTN 5 3 CHF 1 0.6 Stroke 2 1.2 Respiratory infection 10 5.9 CHD-VSD 1 0.6 HN 1 0.6 Chronic disease — None 86 50.9 Note. Values are n (%). Age reported as mean (M). DM = diabetes mellitus; HTN = hypertension; CHF = congestive heart failure; CHD-VSD = congenital heart disease—ventricular septal defect; CNS = central nervous system. Soft tissue infections emerged as the leading primary source of sepsis, accounting for just over one-quarter of cases (26.0%), followed closely by respiratory tract infections (21.9%) and urinary tract infections (16.6%). Intra-abdominal infections comprised 14.8% of presentations, while bloodstream infections contributed 13.0%. Less frequent sites included device-related (3.6%), central nervous system (2.4%), and surgical site infections (1.8%) ( Fig. 1 ) . Comorbid conditions were common, though nearly half of the patients (50.9%) had no documented chronic illness. Diabetes mellitus was the most prevalent comorbidity (20.7%), and a further 15.4% had both diabetes and hypertension. A smaller fraction presented with chronic respiratory disease (5.9%), hypertension alone (3.0%), stroke (1.2%), or cardiac conditions, including congestive heart failure and congenital heart disease ( Table 2 ). Table 2 Vitals, laboratory markers, and neurological status on arrival Vitals, laboratory markers, and neurological status on arrival (n = 169). n % Temperature Fever (possible sepsis) 134 79.3 High-grade fever (Sepsis) 35 20.7 Heart rate (beats/minute) Bradycardia 6 3.6 Tachycardia 140 82.8 Severe tachycardia 23 13.6 Repiratory rate (Breaths/minute) Bradypnea (≤ 11) 14 8.3 Normal ( 12 – 20 ) 106 62.7 Tachypnea ( 21 – 30 ) 33 19.5 Severe tachypnea (≥ 31) 16 9.5 Blood pressure (mmHg) Hypotension/Low MAP 14 8.3 Hypotension; 80/50 47 27.8 Normotensive 108 63.9 Oxygen saturation (%spo2) Mild hypoxia (80–93%) 34 20.1 Severe hypoxia (< 70%) 30 17.8 Normal (93–100%) 105 62.1 Glasgow coma scale (GCS) GCS — Mild impairment ( 13 – 14 ) 32 18.9 GCS — Moderate impairment ( 9 – 12 ) 17 10.1 GCS — Severe impairment (≤ 8) 22 13 GCS — Normal ( 15 ) 98 58 LDH (U/L) LDH — Normal 113 66.9 LDH — High 38 22.5 LDH — Very high 18 10.7 Note. Values are n (%). GCS = Glasgow Coma Scale; LDH = lactate dehydrogenase. At presentation, fever was present in nearly four-fifths of the cohort, and 20.7% had high-grade fever. Tachycardia was strikingly frequent (82.8%), with an additional 13.6% manifesting severe tachycardia. Respiratory derangements were also evident: while most patients maintained a normal respiratory rate, 19.5% were tachypneic and 9.5% severely tachypneic. Hypotension was observed in 36.1%, and oxygen saturation was compromised in a large minority, with 20.1% in severe hypoxia and another 20.1% in mild hypoxia. Neurological assessment showed that 42.0% had some degree of impaired consciousness, with 13.0% in the severe range (GCS ≤ 8) ( Table 2 ). Laboratory investigations reflected the systemic burden of infection. Nearly three-quarters of patients demonstrated leukocytosis, of which one-third had significant elevations, whereas leukopenia was present in 11.2%. Anaemia was frequent, with almost half recording haemoglobin levels < 10 g/dL. Neutrophilia was predominant, occurring in two-thirds of patients. Platelet counts were generally preserved, though 12.4% had thrombocytopenia and 24.9% had thrombocytosis. Biochemical markers revealed evidence of multi-organ stress: more than half had elevated AST and nearly half had raised ALT, while renal impairment was evident in 43.2% with creatinine above 1.3 mg/dL. Severe uremia (> 100 mg/dL) was documented in 20.1%. Hyperbilirubinemia was also common, affecting nearly half of the patients. Elevated procalcitonin levels were recorded in the majority, with 30.2% in the moderate-risk range and 24.9% in the high-risk sepsis range ( Fig. 2 , Table 2 ) Severity scoring further highlighted disease burden. By qSOFA, 37.3% were high risk (≥ 2) ( Fig. 3 ) , and by SOFA, 22.5% had severe dysfunction (≥ 10) ( Fig. 4 ). Multi-organ dysfunction (≥ 3 organs) was present in 8.3% ( Fig. 5 ). These proportions align with multicenter studies such as the ICON and SOAP II cohorts, where organ dysfunction strongly predicted mortality, though the absolute burden in our setting is compounded by limited access to advanced monitoring and supportive therapies. Clinical course and disposition reflected the gravity of illness. More than half of the patients (56.2%) were admitted to the general wards, while over a third required intensive care. A small minority left against medical advice or were discharged directly from the emergency department. Overall mortality was considerable, reaching 30.2%, with survival achieved in 69.2% of patients. Mortality clustered among those with severe organ dysfunction, hypoxia, renal or hepatic derangements, and those admitted to the intensive care unit ( Fig. 6 , Table 3 ). Table 3 Emergency department course and outcomes Emergency department course and outcomes (n = 169). n % ED length of stay <1 week 73 43.2 ED length of stay <2 weeks 24 14.2 ED length of stay < 3 weeks 35 20.7 ED length of stay 2 months 13 7.7 Outcome - Survival 117 69.2 Outcome - Non-survival (death) 51 30.2 Discussion With an overall in-hospital mortality rate of 30.2%, our study demonstrates the high prevalence of sepsis in Somalia, where the majority of patients who visit the emergency department (ED) need to be admitted to the hospital. These results highlight the difficulties in treating sepsis in low-income environments, where poorer outcomes are caused by delayed presentations, a lack of diagnostic capabilities, and restricted critical care resources( 7 , 8 ). However, a major multicenter cohort study conducted in the United States showed that 16.1% of sepsis patients were sent straight from the emergency department for outpatient care, and that their adjusted 30-day mortality was not worse than that of those who were admitted. The disparate realities of sepsis care across resource settings are shown by this startling discrepancy ( 9 , 10 ). UTIs accounted for 16.6% of cases in our population, while respiratory and soft tissue infections were the most common. However, in the US study, pneumonia and intra-abdominal infections were more frequently linked to admission, while UTIs accounted for the majority of cases that were discharged (66.2%)( 11 ). These results imply that the type of infection is a major factor in decisions on how to treat it, with UTIs typically being thought of as having a lower risk of developing multi-organ dysfunction. However, even for UTIs, safe outpatient management is probably impossible in Somalia due to a lack of outpatient follow-up capacity and delays in starting antibiotics( 10 , 12 ). Age, comorbidity burden, and organ dysfunction were found to be important predictors of unfavorable outcomes in both investigations. The most common comorbidities in Somalia were diabetes and hypertension, both of which were strongly linked to a poor prognosis. Likewise, in the US trial, the chance of ED release was reduced by older age, higher SOFA values, and ambulance arrival. However, in Somalia, the absence of outpatient infrastructure forces admission as the default, leaving little space for physician discretion, whereas in the US, physician-level variance greatly influenced disposition( 13 ). This disparity likely reflects differences in health system capacity, access to early resuscitation, and infection control practices. It also highlights that strategies effective in high-income countries, such as outpatient management of selected low-risk sepsis patients, are not readily transferable to low-resource environments ( 11 , 14 ). Our findings reinforce the urgent need for strengthening early recognition, timely antibiotics, and supportive care capacity in Somalia. While outpatient care models for low-risk sepsis patients may reduce unnecessary hospitalisations in high-income settings, in low-income countries with fragile health systems, the priority remains expanding inpatient and critical care infrastructure ( 12 ). However, lessons from risk stratification tools and clinical decision support systems developed in high-income contexts could inform future guideline development once outpatient monitoring systems become more reliable ( 8 , 15 , 16 ). Our prospective study provides one of the first detailed descriptions of sepsis in Somalia, with an overall in-hospital mortality rate of 30.2%, underscoring the heavy burden of sepsis in this low-resource setting. More than one-third of patients required intensive care, reflecting the severity of illness at presentation. The majority of sepsis cases arose from soft tissue, respiratory, and urinary tract infections, with diabetes mellitus and hypertension being the most frequent comorbidities and significant predictors of poor outcomes ( 8 , 17 ). Our findings are consistent with data from Kwizera et al. (2021), who reported similarly high sepsis mortality (34%) in rural Uganda, where limited critical care access, late presentations, and high rates of HIV co-infection contributed to poor outcomes ( 18 , 19 ). Both studies highlight that delayed presentation and restricted availability of ICU beds remain key drivers of mortality in Sub-Saharan Africa. The recent Butaro Hospital pediatric study in Rwanda (Orikiriza et al., 2025) further illustrates this burden in children under five years, reporting 60.5% positive blood cultures and finding female gender (AOR 2.4) and leukocytosis (AOR 6.3) as significant risk factors ( 20 ). While our study involved a mixed-age ED cohort with comorbidity burden as the main driver of mortality, the Rwandan findings emphasize the need for simple diagnostic tools such as WBC counts to triage pediatric patients in resource-limited settings. Together, these studies reinforce the value of basic laboratory diagnostics (CBC, blood cultures) as critical tools for sepsis recognition and timely intervention ( 16 , 21 , 22 ). In contrast, a large multicenter cohort study from the United States (Peltan et al., 2022) found that 16.1% of sepsis patients were safely discharged directly from the ED, with no excess 30-day mortality compared with those admitted ( 23 , 24 ). In our setting, outpatient management is neither feasible nor safe due to the absence of follow-up capacity, delays in antibiotic initiation, and limited community-level monitoring. Additionally, pneumonia and intra-abdominal infections in the US cohort were more predictive of admission, whereas in our population soft tissue infections predominated, suggesting differences in the epidemiology of infection sources across settings ( 18 , 25 ). Age, comorbidity burden, and organ dysfunction were major predictors of poor outcomes in our cohort, consistent with findings from Kwizera et al. and other multicenter studies such as ICON and SOAP II. In our population, tachycardia, hypotension, hypoxia, renal impairment, and hepatic dysfunction were strongly associated with mortality. These findings highlight the importance of early resuscitation, prompt antibiotic administration, and organ support, even in resource-constrained environments ( 18 , 26 , 27 ). Our results highlight the system-level constraints that limit the application of strategies effective in high-income countries. In Somalia, nearly all sepsis patients require inpatient care because of the lack of outpatient infrastructure and community-based follow-up. Investments must prioritize: Early recognition tools (qSOFA screening, CBC availability) ( 28 ). Rapid antibiotic administration and sepsis bundles. Expansion of critical care infrastructure (ICU beds, monitoring capacity, trained staff) ( 12 , 13 ). Strengthened microbiology services to guide antimicrobial stewardship and address emerging multidrug-resistant organisms ( 14 , 29 ). Taken together, our study, the Rwandan pediatric data, and the Ugandan multicenter experience confirm that sepsis is a leading cause of preventable death in East Africa. However, the drivers differ slightly between adults (comorbidities, organ dysfunction) and children (young age, leukocytosis, pathogen profile) ( 10 , 11 , 30 , 31 ). This underlines the need for age-specific sepsis management guidelines and context-appropriate resource allocation, including pediatric blood culture capacity, risk stratification protocols, and robust inpatient follow-up systems ( 8 , 9 ). Limitations Single-Centre Design: Information on 169 patients in one tertiary hospital may not be representative of other Somali or East African settings. Limited Microbiological Data: Blood cultures were not available for all patients, restricting pathogen and resistance information. Resource Constraints: ICU bed availability and advanced monitoring could have influenced management; only 37% of patients were taken to ICU. Short-Term Follow-Up: Only in-hospital outcome was noted, not post-discharge mortality and complications. Selection Bias: Individuals with missing records or early transfers were excluded, perhaps underestimating the severe cases. Sample Size: The limited cohort might make it hard to identify less common risk factors or outcomes. Conclusion: This report points out that sepsis in Somalia is associated with higher morbidity and mortality due to delayed presentation, organ failure, and the lack of limited critical care facilities. When put into perspective against results from Rwanda and Uganda, it is clear that East African sepsis burden is underestimated but real, manifesting both in adult and children. Urgent interventions include improving early recognition, the timely administration of empirical antibiotics, and expanding inpatient and ICU bed capacity. Simple diagnostic markers like WBC count may facilitate early triage, as demonstrated among children. Although management of sepsis as an outpatient may be feasible in developed countries, in developing countries the focus should remain on establishing strong hospital-based care systems and region-specific sepsis guidelines. Increased future multicenter studies in East Africa are urgently needed to further delineate sepsis epidemiology, patterns of antimicrobial resistance, and to measure the implementation of sepsis bundles in these unique settings. Declarations Institutional Review Board Statement Ethical Approval and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki (latest revision, 2024). Ethical approval was obtained from the Mogadishu Somali–Türkiye Training and Research Hospital Research Ethics Committee ( Approval No.: 05.08.2024-MSTH/18792 ). All participants (or their legal guardians, in the case of minors) provided written informed consent to participate. Clinical Trial Number Clinical trial number: not applicable. Consent for Publication Not applicable (no individually identifiable data or images are included). Competing interests Conflicts of interest refer to situations where personal, financial, professional, or other considerations may compromise, or have the appearance of compromising, a person's objectivity, integrity, or judgment in conducting or reporting research, providing reviews, or making decisions. Funding We declare that we have not received any financial support. Author Contribution Abdullahi Ahmed Ahmed: Conceptualisation, research, resources, preparation of original draft, data curation, formal analysis, investigation, review and editing, validation, visualisation, study design, and manuscript preparation.Abdishakur Mohamed Abdirahman and Mohamed Adan Hassan: Data collection and study design support.Sahra Ali Yusuf: Study design, data interpretation, and review and editing of the manuscript.Ismail Mohamoud Abdullahi: Study design development and analysis. Data Availability The data that support the findings of this study are available in Mogadishu Somali Turkey, the Recep Tayyip Erdogan Training and Research Hospital information system. Data are, however, allowed to the authors upon reasonable request and with permission of the education and research committee. References He Y, Xu J, Shang X, Fang X, Gao C, Sun D et al. Clinical characteristics and risk factors associated with ICU-acquired infections in sepsis: A retrospective cohort study. Front Cell Infect Microbiol. 2022 July 28;12:962470. Kwizera A, Urayeneza O, Mujyarugamba P, Baelani I, Meier J, Mer M, et al. Epidemiology and Outcome of Sepsis in Adults and Children in a Rural, Sub-Sahara African Setting. Crit Care Explor. 2021;3(12):e0592. Kahindo CK, Mukuku O, Wembonyama SO, Tsongo ZK. Prevalence and Factors Associated with Acute Kidney Injury in Sub-Saharan African Adults: A Review of the Current Literature. Scholze A, editor. Int J Nephrol. 2022;2022:1–12. 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BMJ Open. 2022;12(12):e064575. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Ahmed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDCCA4wPQBRjA3sDkDKwIEYLswFEC88BkBYJUrRIJIBoIrTw3T7MJvHmj51sv+Tzqxt+FEgw8Ld3J+DVInkumU1ybluy8czZOWU3e4AOkzhzdgNeLQZn+I9J8zYwJ264nZN2gweoxUAil5AWZjZpnj/1iftvnkm7+Yd4LWyHEzdIsB+7TZQtkmeYmS3nth03nnEmh+22jIEED0G/8J1hZrzx5k+1bH/78Wc33/yxkeNv78WvBQx4IKQBgk2kFvYHxKkeBaNgFIyCEQcA3QFIlS+haQAAAAAASUVORK5CYII=","orcid":"","institution":"Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Abdullahi","middleName":"Ahmed","lastName":"Ahmed","suffix":""},{"id":538849256,"identity":"51cae5e4-73e4-47d0-9afc-55fd8adb91bc","order_by":1,"name":"Abdishakur Mohamed Abdirahman","email":"","orcid":"","institution":"Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abdishakur","middleName":"Mohamed","lastName":"Abdirahman","suffix":""},{"id":538849257,"identity":"00d18e36-7e25-44c8-8803-edc60841c269","order_by":2,"name":"Mohamed Adan Hassan","email":"","orcid":"","institution":"Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Adan","lastName":"Hassan","suffix":""},{"id":538849262,"identity":"f09e691c-8b3a-4492-9bca-7a54daf13094","order_by":3,"name":"Ismail Mohamoud Abdullahi","email":"","orcid":"","institution":"Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ismail","middleName":"Mohamoud","lastName":"Abdullahi","suffix":""},{"id":538849264,"identity":"0f90e6bd-5376-46d9-b6f1-3b05571643f4","order_by":4,"name":"Sahra Ali Yusuf","email":"","orcid":"","institution":"Serving as a Nurse at Mogadishu Somali Turkey Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sahra","middleName":"Ali","lastName":"Yusuf","suffix":""}],"badges":[],"createdAt":"2025-10-13 20:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7852067/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7852067/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95320450,"identity":"0a53474d-fafc-4211-9c20-6ff2e1eb8ea3","added_by":"auto","created_at":"2025-11-06 16:39:05","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":216913,"visible":true,"origin":"","legend":"","description":"","filename":"sepsisartcle.docx","url":"https://assets-eu.researchsquare.com/files/rs-7852067/v1/8137ab90bd1dc7a4d5198675.docx"},{"id":95320448,"identity":"36dfd71e-6ce7-4d5d-a573-e25951a815f7","added_by":"auto","created_at":"2025-11-06 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1","display":"","copyAsset":false,"role":"figure","size":250667,"visible":true,"origin":"","legend":"\u003cp\u003eSystemic Inflammatory Response Syndrome (SIRS) Criteria Components\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7852067/v1/7c5de78ecf144828b98cdc3f.jpeg"},{"id":95320449,"identity":"4ec3da2b-1352-4f4c-98fb-9ad02e739666","added_by":"auto","created_at":"2025-11-06 16:39:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14478,"visible":true,"origin":"","legend":"\u003cp\u003eProcalcitonin-Based Risk Stratification of Infection Severity\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7852067/v1/3dceeb09e05cc6bbaae94422.png"},{"id":95523496,"identity":"82968b19-0ca3-4605-bbd5-d283f0e90324","added_by":"auto","created_at":"2025-11-10 09:57:04","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":205364,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Patients by quick Sequential Organ Failure Assessment (qSOFA) Score\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7852067/v1/6f8bf995ee1e882b0f046ad0.jpeg"},{"id":95320453,"identity":"56b62e03-8d70-4e98-9819-433951e0348a","added_by":"auto","created_at":"2025-11-06 16:39:05","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":227419,"visible":true,"origin":"","legend":"\u003cp\u003eSOFA Severity Categories and Associated Risk of Organ Dysfunction\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7852067/v1/1e96c0ce1b2cdd880348855d.jpeg"},{"id":95523632,"identity":"84fe8ff4-8f56-40c0-a876-dc19159aa64b","added_by":"auto","created_at":"2025-11-10 09:59:28","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":17049,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of Organ Dysfunctions per Patient (ARDS, AKI, Liver Dysfunction, Coagulopathy, and Shock)\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7852067/v1/09dba571a0d56bfaa223675d.png"},{"id":95524159,"identity":"22a83b6b-6f94-420b-afac-8f6b4425b3da","added_by":"auto","created_at":"2025-11-10 10:02:24","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":19884,"visible":true,"origin":"","legend":"\u003cp\u003ePatient Disposition and Outcomes (Discharge, Refused Medical Advice, Admitted to Ward, ICU Admission, and Death)\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7852067/v1/7ae4d4c4659023e8550fae52.png"},{"id":104557594,"identity":"5f35846d-2469-4ee1-834b-13a4e5ea8a37","added_by":"auto","created_at":"2026-03-13 09:28:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1803861,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7852067/v1/ceafe23c-c646-4c2b-b4ba-0279f6329e25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Frequency, Characteristics, Risk Factors, and Outcomes Among Patients with Sepsis in the Emergency Department: A Single-Centre Prospective Study in Somalia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSepsis is a devastating global condition characterized by bodily harm owing to infections, leading to inflammatory reactions. This illness is also recognized for the rising mortality rate, particularly among patients referred to the Intensive Care Unit (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The Global Burden of Disease Study reported 48.9\u0026nbsp;million new sepsis cases and 11\u0026nbsp;million sepsis-related deaths in 2017. Additionally, they observed that sepsis fatalities accounted for 19.7% of total global mortality throughout the examined timeframe. The most substantial impact of sepsis was observed in lower-middle-income countries (LMICs), specifically in sub-Saharan Africa, Oceania, South Asia, East Asia, and Southeast Asia (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe patient's integument and the surrounding environment were the sources of germs responsible for SSIs. In both instances, germs may adhere to surgical instruments, potentially contaminating the incision wound, especially during unsanitary surgical practices (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The bulk of these infections are linked to multidrug-resistant bacteria (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Sepsis continues to be a globally life-threatening infection that significantly impairs bodily functions, leading to elevated mortality rates and multiple organ failure. It impacts millions of individuals each year, particularly in low and middle-income nations due to insufficient healthcare infrastructure and critical care resources. In affluent nations, the elderly and individuals with comorbidities are the most impacted, and there exists a well-defined epidemiology and prognosis for the disease. The results offer essential insights into local sepsis epidemiology, enhancing diagnosis and therapy in resource-constrained environments (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study examines Sepsis is a severe infection caused by an out-of-control immune response, leading to tissue injury, organ dysfunction, and high mortality. It is still among the leading causes of mortality and morbidity worldwide, especially in low-resource settings where critical care facilities are limited. The majority of patients in this research were aged between 41 and 60 years, and were slightly more affected in males. The source of the infections was soft tissue, respiratory, and urinary tract. Diabetes mellitus was the most common comorbidity. Fever, tachycardia, hypotension, and respiratory distress were common in clinical presentation, and laboratory findings showed multi-organ injury and elevated Procalcitonin.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e\u003cp\u003eThis prospective descriptive study was conducted at the Emergency Department (ED) of the Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital (MSTH), a leading tertiary referral and teaching hospital in southern Somalia. MSTH serves as a major healthcare provider for over 2\u0026nbsp;million people, offering comprehensive emergency, medical, and critical care services, as well as teaching and research initiatives. The hospital has more than 300 beds and functions as the sole tertiary teaching institution in the region.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study included all patients presenting with sepsis to the ED of MSTH between June 2024 and February 2025. Patients of all ages and genders with suspected or confirmed sepsis were considered eligible. Sepsis was defined according to the Sepsis-3 criteria, with organ dysfunction identified by a SOFA score of 2 or greater in the presence of a suspected or confirmed infection.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eExclusion criteria included:\u003c/h2\u003e\u003cp\u003ePatients with incomplete medical records or transferred out of the hospital before definitive evaluation.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eData were collected prospectively using a standardised data collection form. Trained emergency physicians recorded variables including\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDemographic Information: Age, gender, comorbidities, and other relevant social factors.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eClinical Presentation: Vital signs at ED arrival (temperature, heart rate, respiratory rate, blood pressure, oxygen saturation), neurological status (GCS), and severity scores (qSOFA, SOFA).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSource of Infection: Classification of primary infection site (soft tissue, respiratory, urinary tract, intra-abdominal, bloodstream, device-related, CNS, surgical site).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLaboratory Investigations: Complete blood count, renal and liver function tests, coagulation profile, lactate, and inflammatory markers including procalcitonin.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eManagement and Interventions: Fluid resuscitation, vasopressor support, antibiotic therapy, mechanical ventilation, and ICU admission.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOutcomes: Length of ED stay, disposition (ward, ICU, discharge, death), and in-hospital mortality.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eRisk Factor Assessment\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003ePotential risk factors for sepsis and poor outcomes were systematically assessed, including:\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePatient-related factors: Age, gender, and underlying comorbidities (diabetes, hypertension, chronic respiratory disease, cardiovascular disease).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eInfection-related factors: Source of infection and severity at presentation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eManagement-related factors: Delays in antibiotic administration or supportive therapy.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003ewas obtained from the \u003cb\u003eInstitutional Review Board (IRB) of MSTH (Approval No.: 05.08.2024 MSTH/18792). Written informed consent\u003c/b\u003e was obtained from all patients or their legal guardians before inclusion in the study. Patient confidentiality was strictly maintained, and all procedures were conducted in accordance with the principles outlined in the \u003cb\u003eDeclaration of Helsinki\u003c/b\u003e.\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarise continuous variables as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations or medians with interquartile ranges, and categorical variables as frequencies and percentages. Comparative analyses were conducted using chi-square tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables, as appropriate. Multivariate logistic regression was employed to identify independent risk factors for in-hospital mortality and severe sepsis. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 169 patients were enrolled in the study. The mean age was 45.6 years (range 1\u0026ndash;91), and the largest proportion of cases occurred among adults aged 41\u0026ndash;60 years. Males were slightly more represented than females (58.0% vs. 42.0%)\u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics at ED presentation\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline characteristics at ED presentation (n\u0026thinsp;=\u0026thinsp;169).\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u0026thinsp;=\u0026thinsp;45.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrimary site of Infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBloodstream\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevice-related\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespiratory tract\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrinary tract\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntra-abdominal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCNS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSoft tissue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChronic disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDM with HTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespiratory infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHD-VSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic disease \u0026mdash; None\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eNote.\u003c/span\u003e Values are n (%). Age reported as mean (M). DM\u0026thinsp;=\u0026thinsp;diabetes mellitus; HTN\u0026thinsp;=\u0026thinsp;hypertension; CHF\u0026thinsp;=\u0026thinsp;congestive heart failure; CHD-VSD\u0026thinsp;=\u0026thinsp;congenital heart disease\u0026mdash;ventricular septal defect; CNS\u0026thinsp;=\u0026thinsp;central nervous system.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSoft tissue infections emerged as the leading primary source of sepsis, accounting for just over one-quarter of cases (26.0%), followed closely by respiratory tract infections (21.9%) and urinary tract infections (16.6%). Intra-abdominal infections comprised 14.8% of presentations, while bloodstream infections contributed 13.0%. Less frequent sites included device-related (3.6%), central nervous system (2.4%), and surgical site infections (1.8%)\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eComorbid conditions were common, though nearly half of the patients (50.9%) had no documented chronic illness. Diabetes mellitus was the most prevalent comorbidity (20.7%), and a further 15.4% had both diabetes and hypertension. A smaller fraction presented with chronic respiratory disease (5.9%), hypertension alone (3.0%), stroke (1.2%), or cardiac conditions, including congestive heart failure and congenital heart disease \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVitals, laboratory markers, and neurological status on arrival\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitals, laboratory markers, and neurological status on arrival (n\u0026thinsp;=\u0026thinsp;169).\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTemperature\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever (possible sepsis)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh-grade fever (Sepsis)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeart rate (beats/minute)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBradycardia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTachycardia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere tachycardia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRepiratory rate (Breaths/minute)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBradypnea (\u0026le;\u0026thinsp;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal (\u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTachypnea (\u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere tachypnea (\u0026ge;\u0026thinsp;31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBlood pressure (mmHg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypotension/Low MAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypotension; 80/50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormotensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOxygen saturation (%spo2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild hypoxia (80\u0026ndash;93%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere hypoxia (\u0026lt;\u0026thinsp;70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal (93\u0026ndash;100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGlasgow coma scale (GCS)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGCS \u0026mdash; Mild impairment (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGCS \u0026mdash; Moderate impairment (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGCS \u0026mdash; Severe impairment (\u0026le;\u0026thinsp;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGCS \u0026mdash; Normal (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLDH (U/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDH \u0026mdash; Normal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDH \u0026mdash; High\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDH \u0026mdash; Very high\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eNote.\u003c/span\u003e \u003cem\u003eValues are n (%). GCS\u0026thinsp;=\u0026thinsp;Glasgow Coma Scale; LDH\u0026thinsp;=\u0026thinsp;lactate dehydrogenase.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt presentation, fever was present in nearly four-fifths of the cohort, and 20.7% had high-grade fever. Tachycardia was strikingly frequent (82.8%), with an additional 13.6% manifesting severe tachycardia. Respiratory derangements were also evident: while most patients maintained a normal respiratory rate, 19.5% were tachypneic and 9.5% severely tachypneic. Hypotension was observed in 36.1%, and oxygen saturation was compromised in a large minority, with 20.1% in severe hypoxia and another 20.1% in mild hypoxia. Neurological assessment showed that 42.0% had some degree of impaired consciousness, with 13.0% in the severe range (GCS\u0026thinsp;\u0026le;\u0026thinsp;8) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLaboratory investigations reflected the systemic burden of infection. Nearly three-quarters of patients demonstrated leukocytosis, of which one-third had significant elevations, whereas leukopenia was present in 11.2%. Anaemia was frequent, with almost half recording haemoglobin levels\u0026thinsp;\u0026lt;\u0026thinsp;10 g/dL. Neutrophilia was predominant, occurring in two-thirds of patients. Platelet counts were generally preserved, though 12.4% had thrombocytopenia and 24.9% had thrombocytosis. Biochemical markers revealed evidence of multi-organ stress: more than half had elevated AST and nearly half had raised ALT, while renal impairment was evident in 43.2% with creatinine above 1.3 mg/dL. Severe uremia (\u0026gt;\u0026thinsp;100 mg/dL) was documented in 20.1%. Hyperbilirubinemia was also common, affecting nearly half of the patients. Elevated procalcitonin levels were recorded in the majority, with 30.2% in the moderate-risk range and 24.9% in the high-risk sepsis range \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSeverity scoring further highlighted disease burden. By qSOFA, 37.3% were high risk (\u0026ge;\u0026thinsp;2) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, and by SOFA, 22.5% had severe dysfunction (\u0026ge;\u0026thinsp;10) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Multi-organ dysfunction (\u0026ge;\u0026thinsp;3 organs) was present in 8.3% \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e These proportions align with multicenter studies such as the ICON and SOAP II cohorts, where organ dysfunction strongly predicted mortality, though the absolute burden in our setting is compounded by limited access to advanced monitoring and supportive therapies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eClinical course and disposition reflected the gravity of illness. More than half of the patients (56.2%) were admitted to the general wards, while over a third required intensive care. A small minority left against medical advice or were discharged directly from the emergency department. Overall mortality was considerable, reaching 30.2%, with survival achieved in 69.2% of patients. Mortality clustered among those with severe organ dysfunction, hypoxia, renal or hepatic derangements, and those admitted to the intensive care unit \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEmergency department course and outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency department course and outcomes (n\u0026thinsp;=\u0026thinsp;169).\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eED length of stay \u0026lt;1 week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eED length of stay \u0026lt;2 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eED length of stay\u0026thinsp;\u0026lt;\u0026thinsp;3 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eED length of stay \u0026lt;1 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eED length of stay \u0026gt;2 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome - Survival\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome - Non-survival (death)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith an overall in-hospital mortality rate of 30.2%, our study demonstrates the high prevalence of sepsis in Somalia, where the majority of patients who visit the emergency department (ED) need to be admitted to the hospital.\u003c/p\u003e\u003cp\u003eThese results highlight the difficulties in treating sepsis in low-income environments, where poorer outcomes are caused by delayed presentations, a lack of diagnostic capabilities, and restricted critical care resources(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, a major multicenter cohort study conducted in the United States showed that 16.1% of sepsis patients were sent straight from the emergency department for outpatient care, and that their adjusted 30-day mortality was not worse than that of those who were admitted. The disparate realities of sepsis care across resource settings are shown by this startling discrepancy (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUTIs accounted for 16.6% of cases in our population, while respiratory and soft tissue infections were the most common. However, in the US study, pneumonia and intra-abdominal infections were more frequently linked to admission, while UTIs accounted for the majority of cases that were discharged (66.2%)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese results imply that the type of infection is a major factor in decisions on how to treat it, with UTIs typically being thought of as having a lower risk of developing multi-organ dysfunction. However, even for UTIs, safe outpatient management is probably impossible in Somalia due to a lack of outpatient follow-up capacity and delays in starting antibiotics(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAge, comorbidity burden, and organ dysfunction were found to be important predictors of unfavorable outcomes in both investigations. The most common comorbidities in Somalia were diabetes and hypertension, both of which were strongly linked to a poor prognosis.\u003c/p\u003e\u003cp\u003eLikewise, in the US trial, the chance of ED release was reduced by older age, higher SOFA values, and ambulance arrival. However, in Somalia, the absence of outpatient infrastructure forces admission as the default, leaving little space for physician discretion, whereas in the US, physician-level variance greatly influenced disposition(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis disparity likely reflects differences in health system capacity, access to early resuscitation, and infection control practices. It also highlights that strategies effective in high-income countries, such as outpatient management of selected low-risk sepsis patients, are not readily transferable to low-resource environments (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur findings reinforce the urgent need for strengthening early recognition, timely antibiotics, and supportive care capacity in Somalia. While outpatient care models for low-risk sepsis patients may reduce unnecessary hospitalisations in high-income settings, in low-income countries with fragile health systems, the priority remains expanding inpatient and critical care infrastructure (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, lessons from risk stratification tools and clinical decision support systems developed in high-income contexts could inform future guideline development once outpatient monitoring systems become more reliable (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur prospective study provides one of the first detailed descriptions of sepsis in Somalia, with an overall in-hospital mortality rate of 30.2%, underscoring the heavy burden of sepsis in this low-resource setting. More than one-third of patients required intensive care, reflecting the severity of illness at presentation. The majority of sepsis cases arose from soft tissue, respiratory, and urinary tract infections, with diabetes mellitus and hypertension being the most frequent comorbidities and significant predictors of poor outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur findings are consistent with data from Kwizera et al. (2021), who reported similarly high sepsis mortality (34%) in rural Uganda, where limited critical care access, late presentations, and high rates of HIV co-infection contributed to poor outcomes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Both studies highlight that delayed presentation and restricted availability of ICU beds remain key drivers of mortality in Sub-Saharan Africa. The recent Butaro Hospital pediatric study in Rwanda (Orikiriza et al., 2025) further illustrates this burden in children under five years, reporting 60.5% positive blood cultures and finding female gender (AOR 2.4) and leukocytosis (AOR 6.3) as significant risk factors (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). While our study involved a mixed-age ED cohort with comorbidity burden as the main driver of mortality, the Rwandan findings emphasize the need for simple diagnostic tools such as WBC counts to triage pediatric patients in resource-limited settings. Together, these studies reinforce the value of basic laboratory diagnostics (CBC, blood cultures) as critical tools for sepsis recognition and timely intervention (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn contrast, a large multicenter cohort study from the United States (Peltan et al., 2022) found that 16.1% of sepsis patients were safely discharged directly from the ED, with no excess 30-day mortality compared with those admitted (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In our setting, outpatient management is neither feasible nor safe due to the absence of follow-up capacity, delays in antibiotic initiation, and limited community-level monitoring. Additionally, pneumonia and intra-abdominal infections in the US cohort were more predictive of admission, whereas in our population soft tissue infections predominated, suggesting differences in the epidemiology of infection sources across settings (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAge, comorbidity burden, and organ dysfunction were major predictors of poor outcomes in our cohort, consistent with findings from Kwizera et al. and other multicenter studies such as ICON and SOAP II. In our population, tachycardia, hypotension, hypoxia, renal impairment, and hepatic dysfunction were strongly associated with mortality. These findings highlight the importance of early resuscitation, prompt antibiotic administration, and organ support, even in resource-constrained environments (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur results highlight the system-level constraints that limit the application of strategies effective in high-income countries. In Somalia, nearly all sepsis patients require inpatient care because of the lack of outpatient infrastructure and community-based follow-up. Investments must prioritize: Early recognition tools (qSOFA screening, CBC availability) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Rapid antibiotic administration and sepsis bundles. Expansion of critical care infrastructure (ICU beds, monitoring capacity, trained staff) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Strengthened microbiology services to guide antimicrobial stewardship and address emerging multidrug-resistant organisms (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTaken together, our study, the Rwandan pediatric data, and the Ugandan multicenter experience confirm that sepsis is a leading cause of preventable death in East Africa. However, the drivers differ slightly between adults (comorbidities, organ dysfunction) and children (young age, leukocytosis, pathogen profile) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). This underlines the need for age-specific sepsis management guidelines and context-appropriate resource allocation, including pediatric blood culture capacity, risk stratification protocols, and robust inpatient follow-up systems (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eSingle-Centre Design: Information on 169 patients in one tertiary hospital may not be representative of other Somali or East African settings.\u003c/p\u003e\u003cp\u003eLimited Microbiological Data: Blood cultures were not available for all patients, restricting pathogen and resistance information.\u003c/p\u003e\u003cp\u003eResource Constraints: ICU bed availability and advanced monitoring could have influenced management; only 37% of patients were taken to ICU.\u003c/p\u003e\u003cp\u003eShort-Term Follow-Up: Only in-hospital outcome was noted, not post-discharge mortality and complications.\u003c/p\u003e\u003cp\u003eSelection Bias: Individuals with missing records or early transfers were excluded, perhaps underestimating the severe cases.\u003c/p\u003e\u003cp\u003eSample Size: The limited cohort might make it hard to identify less common risk factors or outcomes.\u003c/p\u003e\u003cp\u003eConclusion: This report points out that sepsis in Somalia is associated with higher morbidity and mortality due to delayed presentation, organ failure, and the lack of limited critical care facilities. When put into perspective against results from Rwanda and Uganda, it is clear that East African sepsis burden is underestimated but real, manifesting both in adult and children. Urgent interventions include improving early recognition, the timely administration of empirical antibiotics, and expanding inpatient and ICU bed capacity. Simple diagnostic markers like WBC count may facilitate early triage, as demonstrated among children. Although management of sepsis as an outpatient may be feasible in developed countries, in developing countries the focus should remain on establishing strong hospital-based care systems and region-specific sepsis guidelines. Increased future multicenter studies in East Africa are urgently needed to further delineate sepsis epidemiology, patterns of antimicrobial resistance, and to measure the implementation of sepsis bundles in these unique settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eInstitutional Review Board Statement\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki (latest revision, 2024). Ethical approval was obtained from the Mogadishu Somali\u0026ndash;T\u0026uuml;rkiye Training and Research Hospital Research Ethics Committee (\u003cb\u003eApproval No.: 05.08.2024-MSTH/18792\u003c/b\u003e). All participants (or their legal guardians, in the case of minors) provided written informed consent to participate.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eClinical Trial Number\u003c/h2\u003e\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003ch2\u003eConsent for Publication\u003c/h2\u003e\u003cp\u003eNot applicable (no individually identifiable data or images are included).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eConflicts of interest refer to situations where personal, financial, professional, or other considerations may compromise, or have the appearance of compromising, a person's objectivity, integrity, or judgment in conducting or reporting research, providing reviews, or making decisions.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eWe declare that we have not received any financial support.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAbdullahi Ahmed Ahmed: Conceptualisation, research, resources, preparation of original draft, data curation, formal analysis, investigation, review and editing, validation, visualisation, study design, and manuscript preparation.Abdishakur Mohamed Abdirahman and Mohamed Adan Hassan: Data collection and study design support.Sahra Ali Yusuf: Study design, data interpretation, and review and editing of the manuscript.Ismail Mohamoud Abdullahi: Study design development and analysis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available in Mogadishu Somali Turkey, the Recep Tayyip Erdogan Training and Research Hospital information system. Data are, however, allowed to the authors upon reasonable request and with permission of the education and research committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHe Y, Xu J, Shang X, Fang X, Gao C, Sun D et al. Clinical characteristics and risk factors associated with ICU-acquired infections in sepsis: A retrospective cohort study. Front Cell Infect Microbiol. 2022 July 28;12:962470.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKwizera A, Urayeneza O, Mujyarugamba P, Baelani I, Meier J, Mer M, et al. Epidemiology and Outcome of Sepsis in Adults and Children in a Rural, Sub-Sahara African Setting. Crit Care Explor. 2021;3(12):e0592.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKahindo CK, Mukuku O, Wembonyama SO, Tsongo ZK. Prevalence and Factors Associated with Acute Kidney Injury in Sub-Saharan African Adults: A Review of the Current Literature. Scholze A, editor. Int J Nephrol. 2022;2022:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMisha G, Chelkeba L, Melaku T. Incidence, risk factors and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia: Prospective cohort study. Ann Med Surg [Internet]. 2021 May [cited 2025 Aug 30];65. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amsu.2021.102247\u003c/span\u003e\u003cspan address=\"10.1016/j.amsu.2021.102247\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhite KC, Serpa-Neto A, Hurford R, Clement P, Laupland KB, See E, et al. 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J Pediatr (Rio J). 2021;97(3):287\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSinger M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSabir L, Wharton L, Goodacre S. Retrospective single-centre descriptive study of the characteristics, management and outcomes of adult patients with suspected sepsis in the emergency department. Emerg Med J. 2022;39(4):272\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRedfern OC, Smith GB, Prytherch DR, Meredith P, Inada-Kim M, Schmidt PE. A Comparison of the Quick Sequential (Sepsis-Related) Organ Failure Assessment Score and the National Early Warning Score in Non-ICU Patients With/Without Infection. Crit Care Med. 2018;46(12):1923\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerin J, Mulick A, Yeung D, Villavicencio F, Lopez G, Strong KL, et al. Global, regional, and national causes of under-5 mortality in 2000\u0026ndash;19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022;6(2):106\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBa-alwi NA, Aremu JO, Ntim M, Takam R, Msuya MA, Nassor H, et al. Bacteriological Profile and Predictors of Death Among Neonates With Blood Culture-Proven Sepsis in a National Hospital in Tanzania\u0026mdash;A Retrospective Cohort Study. Front Pediatr. 2022;10:797208.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgnello L, Giglio RV, Bivona G, Scazzone C, Gambino CM, Iacona A, et al. The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis. Diagnostics. 2021;11(10):1881.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAssemie MA, Alene M, Yismaw L, Ketema DB, Lamore Y, Petrucka P, et al. Prevalence of Neonatal Sepsis in Ethiopia: A Systematic Review and Meta-Analysis. Int J Pediatr. 2020;2020:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMigamba SM, Kisaakye E, Komakech A, Nakanwagi M, Nakamya P, Mutumba R, et al. Trends and spatial distribution of neonatal sepsis, Uganda, 2016\u0026ndash;2020. BMC Pregnancy Childbirth. 2023;23(1):770.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDe Groot B, Stolwijk F, Warmerdam M, Lucke JA, Singh GK, Abbas M, et al. The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study. Scand J Trauma Resusc Emerg Med. 2017;25(1):91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHopkinson DA, Mvukiyehe JP, Jayaraman SP, Syed AA, Dworkin MS, Mucyo W et al. Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality. Ehrman R, editor. PLOS ONE. 2021;16(5):e0251321.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarrol ED, Ranjit S, Menon K, Bennett TD, Sanchez-Pinto LN, Zimmerman JJ, et al. Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce. Pediatr Crit Care Med. 2023 June;24(6):e263\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBray A, Kampouraki E, Winter A, Jesuthasan A, Messer B, Graziadio S. High Variability in Sepsis Guidelines in UK: Why Does It Matter? Int J Environ Res Public Health. 2020;17(6):2026.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenning DJ, Puskarich MA, Self WH, Howell MD, Donnino MW, Yealy DM, et al. An Emergency Department Validation of the SEP-3 Sepsis and Septic Shock Definitions and Comparison With 1992 Consensus Definitions. Ann Emerg Med. 2017;70(4):544\u0026ndash;e5525.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGray A, Ward K, Lees F, Dewar C, Dickie S, McGuffie C, et al. The epidemiology of adults with severe sepsis and septic shock in Scottish emergency departments. Emerg Med J. 2013;30(5):397\u0026ndash;401.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNishie H. Guidelines for management of severe sepsis and septic shock. Okayama Igakkai Zasshi J Okayama Med Assoc. 2013;125(2):153\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMwiseneza I, Nkomeje A, Umuhoza A, Mukwesi C, Hategekimana S. Factors related to sepsis in critical care setting in Rwanda selected referral hospital. Afr J Health Sci. 2024;36(6):652\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKayange N, Kamugisha E, Mwizamholya DL, Jeremiah S, Mshana SE. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania. BMC Pediatr. 2010;10(1):39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoulden R, Hoyle MC, Monis J, Railton D, Riley V, Martin P, et al. qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J. 2018 June;35(6):345\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrikiriza P, Ruhangaza D, Ayebare DS, Bizimana E, Niyibizi JB, Nshimiyimana I et al. Prevalence, pathogenic bacteria, and risk factors associated with pediatric sepsis among under five children in a rural district hospital in Rwanda. Amanati A, editor. PLOS One. 2025 June 27;20(6):e0327425.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTumuhamye J, Sommerfelt H, Bwanga F, Ndeezi G, Mukunya D, Napyo A et al. Neonatal sepsis at Mulago national referral hospital in Uganda: Etiology, antimicrobial resistance, associated factors and case fatality risk. Butaye P, editor. PLOS ONE. 2020;15(8):e0237085.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStaunton AP, Nabwera HM, Allen SJ, Tongo OO, Akindolire AE, Abdulkadir I, et al. Prospective observational study of the challenges in diagnosing common neonatal conditions in Nigeria and Kenya. BMJ Open. 2022;12(12):e064575.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sepsis, Emergency Department, Somalia, Resource-Limited Settings, Risk Factors, Mortality, Organ Dysfunction","lastPublishedDoi":"10.21203/rs.3.rs-7852067/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7852067/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSepsis is a serious condition associated with significant morbidity and death, especially in resource-limited settings. In Somalia, data on the incidence, clinical features, and outcomes of sepsis is limited. This study sought to delineate the prevalence, risk factors, and outcomes of sepsis in patients admitted to a tertiary hospital emergency department.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA prospective descriptive study was performed at the Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital from June 2024 to February 2025. Individuals of all ages with suspected or confirmed sepsis, as defined by Sepsis-3 criteria, were included. Demographic data, comorbidities, clinical presentations, laboratory results, management strategies, and in-hospital outcomes were gathered and analyzed by descriptive and inferential statistics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 169 patients were enrolled (mean age 45.6 years; 58% male). The predominant causes of infection were soft tissue (26%), pulmonary (21.9%), and urinary tract infections (16.6%). Comorbidities were observed in 49.1% of patients, with diabetes (20.7%) and hypertension (15.4%) being the most prevalent. Clinical observations comprised fever (79%), tachycardia (82.8%), hypotension (36.1%), hypoxia (40.2%), and altered awareness (42%). Laboratory findings indicated multi-organ involvement, comprising renal impairment (43.2%), hepatic dysfunction, leukocytosis (72.8%), and increased procalcitonin levels (55.1%). The overall in-hospital death rate was 30.2%, with risk factors comprising advanced age, comorbidities, hypotension, hypoxia, and multi-organ failure.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSepsis in Somalia is linked to significant morbidity and mortality, worsened by delayed presentation, comorbidities, and insufficient critical care resources. Enhancing early detection, timely antibiotic treatment, and increasing inpatient and ICU capacity are crucial. These findings underscore the pressing necessity for context-specific sepsis protocols and resource-appropriate care options in low-income environments.\u003c/p\u003e","manuscriptTitle":"Frequency, Characteristics, Risk Factors, and Outcomes Among Patients with Sepsis in the Emergency Department: A Single-Centre Prospective Study in Somalia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-06 16:39:00","doi":"10.21203/rs.3.rs-7852067/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1258b22-c0ba-484a-b556-e27e7bf296ba","owner":[],"postedDate":"November 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T09:25:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-06 16:39:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7852067","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7852067","identity":"rs-7852067","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}