Gordon B, Nyiro JU, Nair H, Sheikh Z, Katama E, Agoti CN, Pei R, Zar H, Shi T
J Infect Dis. 2025;
BACKGROUND: Acute lower respiratory tract infections (ALRIs) are a leading cause of paediatric mortality in low- and middle-income countries. In recent years, substantial research has been done to enhance risk stratification of children presenting with ALRIs, in a bid to improve health outcomes in resource-limited settings. We sought to analyse the performance of several paediatric ALRI risk scores in the prediction of mortality among children hospitalised with ALRIs in Kenya. METHODS: We retrospectively analysed the data of 2182 children aged 2-24 months who were admitted to Kilifi County Referral Hospital, Kenya with severe ALRIs between January 2015 and December 2024. We evaluated the performance of 6 ALRI risk scores (RISC (HIV-Negative), mRISC, RISC-Malawi, PERCH, PREPARE, ReSVinet) in this population. Additionally, we created and evaluated a modified version of the ReSVinet score by including nutrition status. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS: The mid-upper arm circumference (MUAC) version of the RISC-Malawi score showed the highest discrimination for the outcome of in-hospital mortality (AUROC: 0.83, 95% CI: (0.79-0.86)), whilst all other scores showed acceptable discrimination (AUROC: 0.70-0.79). The modification of ReSVinet to include nutrition status significantly improved its AUROC from 0.72 to 0.79. CONCLUSION: All risk scores showed at least fair performance in the prediction of in-hospital mortality within our dataset. The RISC-Malawi (MUAC) score appears to be the most promising candidate for future implementation, however further research is needed to evaluate the calibration, feasibility and clinical utility of these scores.
