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Background and Purpose- Rates of intracerebral hemorrhage (ICH) are estimated to be highest globally in sub-Saharan Africa. However, outcomes of ICH are poorly described and standard prognostic markers for ICH have not been validated in the region. Methods- We enrolled consecutive patients with computed tomography-confirmed ICH at a referral hospital in southwestern Uganda. We recorded demographic, clinical, and radiographic features of ICH, and calculated ICH scores. We fit Poisson regression models with robust variance estimation to determine predictors of case fatality at 30 days. Results- We enrolled 73 individuals presenting with computed tomography-confirmed ICH (mean age 60 years, 45% [33/73] female, and 14% [10/73] HIV-positive). The median ICH score was 2 (interquartile range, 1-3; range, 0-5). Case fatality at 30 days was 44% (32/73; 95% CI, 33%-57%). The 30-day case fatality increased with increasing ICH score of 0, 1, and 5 from 17%, 23%, to 100%, respectively. In multivariable-adjusted models, ICH score was associated with case fatality (adjusted relative risk, 1.48; 95% CI, 1.23-1.78), as were HIV infection (adjusted relative risk, 1.92; 95% CI, 1.07-3.43) and female sex (adjusted relative risk, 2.17; 95% CI, 1.32-3.59). The ICH score moderately improved with the addition of a point each for female sex and HIV serostatus (0.81 versus 0.73). Conclusions- ICH score at admission is a strong prognostic indicator of 30-day case fatality in Uganda. Our results support its role in guiding the care of patients presenting with ICH in the region.

Sepsis is the leading cause of global death with the highest burden found in sub-Saharan Africa (sSA). The Universal Vital Assessment (UVA) score is a validated resource-appropriate clinical tool to identify hospitalized patients in sSA who are at risk of in-hospital mortality. Whether a decrease in the UVA score over 6 hours of resuscitation from sepsis is associated with improved outcomes is unknown. We aimed to determine (1) the association between 6-hour UVA score and in-hospital mortality, and (2) if a decrease in UVA score from admission to 6 hours was associated with improved in-hospital mortality. We analyzed data from participants with severe sepsis aged ≥14 years enrolled at the Mbarara Regional Referral Hospital in Uganda from October 2014 through May 2015. Among 197 participants, the median (interquartile range) age was 34 (27-47) years, 99 (50%) were female and 116 (59%) were living with HIV. At 6 hours, of the 65 participants in the high-risk group, 28 (43%) died compared to 28 (30%) of 94 in the medium-risk group (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.29,1.08, p = 0.086) and 3 (9%) of 33 in the low-risk group (OR 0.13, 95% CI 0.03, 0.42, p = 0.002). In a univariate analysis of the 85 participants who improved their UVA risk group at 6 hours, 20 (23%) died compared to 39 (36%) of 107 participants who did not improve (OR 0.54, 95% CI 0.27-1.06, p = 0.055). In the multivariable analysis, the UVA score at 6 hours (adjusted OR [aOR] 1.26, 95%CI 1.10-1.45, p<0.001) was associated with in-hospital mortality. When adjusted for age and sex, improvement in the UVA risk group over 6 hours was associated with a non-statistically significant 43% decrease in odds of mortality (aOR 0.57, 95%CI 0.29-1.07, p = 0.08). Targeting a decrease in UVA score over 6 hours from admission may be a useful clinical endpoint for sepsis resuscitation in sSA, but this would need to be proven in a clinical trial., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Null et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)