Clinical Characteristics, outcomes, and mortality predictors of sepsis patients in an East African emergency department at Mogadishu, Somalia: an observational cohort study

Abstract

Sepsis is a life-threatening syndrome associated with substantial morbidity and mortality, particularly in low- and middle-income countries (LMICs), where prospective emergency department data remain limited. In Somalia, evidence describing the clinical characteristics and outcomes of sepsis is scarce. We conducted a prospective observational cohort study of adult patients (≥ 18 years) presenting with sepsis to the emergency department of Mogadishu Somalia Türkiye Recep Tayyip Erdoğan Training and Research Hospital between June 2024 and February 2025. Sepsis was defined according to Sepsis-3 criteria as suspected or confirmed infection with a Sequential Organ Failure Assessment (SOFA) score ≥ 2. Demographic, clinical, laboratory, and outcome data were prospectively collected. Multivariable binary logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Among 7,200 emergency department presentations, 169 patients (2.35%) met Sepsis-3 criteria and were included in the analysis. The median age was 46 years (IQR 29–63), and 58.0% were male. Comorbidities were present in 49.1% of patients, most commonly diabetes mellitus (20.7%) and combined diabetes–hypertension (15.4%). The leading infection sources were soft tissue (26.0%), respiratory tract (21.9%), urinary tract (16.6%), and intra-abdominal infections (14.8%).At presentation, 79.3% of patients were febrile, 96.4% tachycardic, 36.1% hypotensive, and 40.2% hypoxic. Laboratory abnormalities included leukocytosis, anemia, elevated serum creatinine, and abnormal liver function tests, reflecting significant organ dysfunction.Overall, in-hospital mortality was 30.2%. In multivariable analysis, independent predictors of mortality included age > 60 years (adjusted odds ratio [aOR] 2.15, 95% CI 1.12–4.10), severe hypoxia (aOR 4.20, 95% CI 2.10–8.50), higher SOFA score (per-point increase), and elevated serum creatinine > 1.3 mg/dL (aOR 2.84, 95% CI 1.32–6.11). Sepsis in this tertiary emergency department in Somalia was associated with high in-hospital mortality. Advanced age, severe hypoxia, organ dysfunction severity, and renal impairment were independent predictors of death. Strengthening early sepsis recognition, timely antimicrobial therapy, and critical care capacity may improve outcomes in resource-limited settings. Not applicable.