Predictive performance of clinical scores and survival outcomes in critically ill patients with sepsis: a prospective longitudinal study at a tertiary medical centre in Ethiopia

Background Clinical scores such as quick sequential organ failure assessment (qSOFA), early warning score (EWS), and universal vital assessment (UVA) are commonly used as screening and prognostic tools in sepsis. However, consistent findings across different regions and hospital settings remain limited. This study aims to evaluate the performance of these clinical scores and identify predictors of survival in septic adults admitted to the ICU. Methods A prospective longitudinal study was conducted from October 10, 2023, to October 9, 2024, involving adults admitted to the intensive care unit (ICU). Clinical scores were calculated on the first, third, and fifth days of admission. Their performance in detecting sepsis, identifying culture-positive cases, and predicting mortality was assessed using receiver operating characteristic (ROC) curves. Kaplan–Meier survival analysis was used to estimate survival probabilities, and a Cox proportional hazards model was applied to identify predictors of survival in sepsis patients. Results Of the ICU-admitted patients, 148 (51.9%) were septic, and 54 (36.5%) of them died in the ICU. The modified early warning score (MEWS) showed good performance in identifying sepsis (area under the curve (AUC) = 0.67; 95% confidence interval (CI) 0.61–0.73) and culture-positive cases (AUC = 0.65; 95% CI 0.50–0.80) on the day of admission. MEWS also performed better in predicting mortality on day five (AUC = 0.75; 95% CI 0.57–0.93). Patients with sepsis had significantly lower survival probabilities than those without sepsis (log-rank test, p < 0.001). Each additional point in the Glasgow Coma Scale (GCS) score reduced the hazard of death by 10% (HR = 0.90; 95% CI 0.84–0.97; p = 0.005). Conclusion The MEWS score outperformed other clinical scores in identifying sepsis, detecting culture-positive cases, and predicting mortality. Sepsis was associated with higher mortality, which decreased with increasing GCS scores. MEWS may support early identification of sepsis and mortality risk, and its use could help improve ICU survival through timely intervention.