The inability to walk unassisted at hospital admission as a valuable triage tool to predict hospital mortality in Rwandese patients with suspected infection

• Type of Material: Article
• Authors: Arthur Kwizera, Makerere University; Olivier Urayeneza, Gitwe Hospital; Pierre Mujyarugamba, Gitwe Hospital; Jens Meier, Kepler Universitätsklinikum; Andrew Patterson, Emory University; Lori Harmon, Society of Critical Care Medicine; Joseph C. Farmer, Mayo Clinic Scottsdale-Phoenix; Martin W. Dünser, Kepler Universitätsklinikum
• Language: English
• Date: 2020-01-01
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Kwizera et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0228966
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 15
• Issue: 2
• Start Page: e0228966
• End Page: e0228966
• Grant/Funding Information: Arthur Kwizera is supported by DELTAS Africa Initiative grant #DEL-15-011 to THRiVE-2. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust grant #107742/Z/15/Z and the UK government; This study was funded by the Life Priority Fund, the Hellman Foundation and the King Baudouin Foundation; The research project was supported by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine through the Surviving Sepsis Campaign
• Keywords: Intensive Care Units; ROC Curve; Sepsis; Diagnostic Tests, Routine; Rwanda; Infections; Adolescent; Prognosis; Male; Area Under Curve; Retrospective Studies; Child; Risk Factors; Adult; Sensitivity and Specificity; Hospital Mortality; Severity of Illness Index; Prospective Studies; Length of Stay; Walking; Triage; Humans; Hospitalization; Female
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Objective To assess the value of the inability to walk unassisted to predict hospital mortality in patients with suspected infection in a resource-limited setting. Methods This is a post hoc study of a prospective trial performed in rural Rwanda. Patients hospitalized because of a suspected acute infection and who were able to walk unassisted before this disease episode were included. At hospital presentation, the walking status was graded into: 1) can walk unassisted, 2) can walk assisted only, 3) cannot walk. Receiver operating characteristic (ROC) analyses and two-by-two tables were used to determine the sensitivity, specificity, negative and positive predictive values of the inability to walk unassisted to predict in-hospital death. Results One-thousand-sixty-nine patients were included. Two-hundred-one (18.8%), 315 (29.5%), and 553 (51.7%) subjects could walk unassisted, walk assisted or not walk, respectively. Their hospital mortality was 0%, 3.8% and 6.3%, respectively. The inability to walk unassisted had a low specificity (20%) but was 100% sensitive (CI95%, 90–100%) to predict in-hospital death (p = 0.00007). The value of the inability to walk unassisted to predict in-hospital mortality (AUC ROC, 0.636; CI95%, 0.564–0.707) was comparable to that of the qSOFA score (AUC ROC, 0.622; CI95% 0.524–0.728). Fifteen (7.5%), 34 (10.8%) and 167 (30.2%) patients who could walk unassisted, walk assisted or not walk presented with a qSOFA score count ≥2 points, respectively (p<0.001). The inability to walk unassisted correlated with the presence of risk factors for death and danger signs, vital parameters, laboratory values, length of hospital stay, and costs of care. Conclusions Our results suggest that the inability to walk unassisted at hospital admission is a highly sensitive predictor of in-hospital mortality in Rwandese patients with a suspected acute infection. The walking status at hospital admission appears to be a crude indicator of disease severity.