title: Feasibility of the modified sequential organ function assessment score in a resource-constrained setting: a prospective observational study.
abstract: Sub-Saharan Africa has a great burden of critical illness with limited health care resources. We evaluated the feasibility and utility of the modified Sequential Organ Function Assessment (mSOFA) score in assessing morbidity and mortality in the National Referral Hospital's intensive care unit (ICU) for one year.
  
  
  
  We conducted a prospective, observational cohort study on patients above 12 years of age admitted to the ICU at Mulago Hospital (Kampala, Uganda). All SOFA scores were determined at admission and at 48 h. We modified the SOFA score by replacing the PaO2/FiO2ratio with SPO2/FiO2. The primary outcome was ICU mortality.
  
  
  
  This ICU cohort of 118 patients had a mean age of 37 years and an ICU mortality rate of 46.6%. Non-survivors had higher initial (7.7 SD 3.8 vs. 5.5 SD 3.3; p = 0.007), mean (8.1 SD 3.9 vs 4.7 SD 2.6; p < 0.001) and highest mSOFA scores (9.4 SD 4.2 vs. 5.8 SD 3.2; p < 0.001), with an increase of 1.0 (SD 3.1) mSOFA on average after 48 h when compared to survivors (p < 0.001). The area under the receiver operating characteristic curves for each mSOFA category was: initial-0.68, mean-0.76, highest-0.76 and delta mSOFA-0.74. Multivariate logistic regression analysis showed no significant association between mSOFA scores and mortality.
  
  
  
  Our results confirm that calculation of the mSOFA score is feasible for an ICU population in a resource-limited country. More data are needed to test for an association between mSOFA and mortality.
authors.affiliation: Department of Anesthesia and critical care,, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. cornels77@gmail.com.
authors.forename: Cornelius
authors.identifier: 0000-0002-9039-7325
authors.initials: C
authors.lastname: Sendagire
authors.affiliation: San Francisco General Hospital, University of California San Francisco, 1001 Potrero, 3C24, San Francisco, CA, 94110, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lipnick
authors.affiliation: Department of Anesthesia and critical care,, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: Sam
authors.initials: S
authors.lastname: Kizito
authors.affiliation: McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kruisselbrink
authors.affiliation: Department of Anesthesia and critical care,, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: Daniel
authors.initials: D
authors.lastname: Obua
authors.affiliation: Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ejoku
authors.affiliation: Department of Anesthesia and critical care,, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: Lameck
authors.initials: L
authors.lastname: Ssemogerere
authors.affiliation: Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda.
authors.forename: Jane
authors.initials: J
authors.lastname: Nakibuuka
authors.affiliation: Department of Anesthesia and critical care,, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kwizera
mesh_terms: D000328:Adult; D016638:Critical Illness; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009026:Mortality; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D014454:Uganda; D055815:Young Adult
keywords: Critical care; Illness severity scoring system; Low and middle-income countries; Modified sequential organ function assessment; Mortality