Predictors of ICU Mortality in Septic Patients in a Resource-Limited African Setting: A Prospective Multicenter Cohort Study in Lubumbashi, DRC

Background Sepsis remains a leading cause of intensive care unit (ICU) mortality globally, with the highest burden observed in low- and middle-income countries where diagnostic capacity, timely referral, and access to organ support are limited. However, commonly used prognostic tools rely on laboratory and monitoring resources that are often unavailable in such settings. This study aimed to identify independent predictors of ICU mortality among adults with sepsis in Lubumbashi, Democratic Republic of the Congo, and to develop a context-adapted prognostic score suitable for resource-constrained environments. Methods We conducted a prospective multicentre cohort study across three ICUs between January 2021 and April 2023. Adults meeting Sepsis-3 criteria were consecutively enrolled. Clinical status, basic laboratory parameters, therapeutic timing, and socioeconomic characteristics were recorded within 24 hours of ICU admission. Independent predictors of 28-day mortality were identified using multivariable logistic regression. A simplified point-based prognostic model (SPARS-Basique) was constructed and evaluated for discrimination (AUROC) and calibration, with internal validation using bootstrap resampling (1,000 iterations). Results A total of 136 patients were included (median age 48 years). ICU mortality was 78%, with most deaths occurring within the first five days of admission. Nine variables independently predicted mortality: age ≥ 60 years, low socioeconomic status, absence of health insurance, delay > 5 days before ICU admission, Glasgow Coma Scale ≤ 10, SpO₂ <90%, shock index ≥ 0.9, serum creatinine ≥ 3 mg/dL, and blood glucose ≥ 8 mmol/L. These variables formed the SPARS-Basique score (0–18 points). The model demonstrated strong discrimination (AUROC 0.89; bootstrap-corrected AUROC 0.87) and good calibration. Observed mortality increased across risk groups: 21% (score 0–5), 64% (6–9), and 91% (≥ 10). Conclusions Sepsis mortality in Lubumbashi ICUs is extremely high and is influenced by both biological severity and structural barriers to timely care. The SPARS-Basique score provides a pragmatic bedside tool for early risk stratification and allocation of limited critical care resources. External validation and implementation studies are required to assess its generalisability.