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Development and pilot testing of the AMPS model for predicting ICU mortality in low and middle income countries
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  • Published: 26 February 2026

Development and pilot testing of the AMPS model for predicting ICU mortality in low and middle income countries

  • Finot Debebe1,
  • Abate Yeshidinber Weldetsadik2,
  • Adam Laytin3,
  • Alberto Goffi4,
  • Getaw Hassen5,
  • Menbeu Sultan2,
  • Lemlem Beza1,
  • Merahi Kefyalew Merahi1,
  • Ayalew Zewdie6,
  • Yared Firissa7,
  • Woldesenbet Waganew2,
  • Emnet Tesfaye Shimber6 &
  • …
  • Neill Adhikari4 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Biomarkers
  • Diseases
  • Health care
  • Medical research
  • Risk factors

Abstract

Mortality prediction models developed in high-income country intensive care units (ICUs) may perform poorly in low–middle-income country (LMIC) ICUs due to differences in case mix and provision of life-supporting interventions. This study aims to develop a novel prognostic score and investigate its precision, discrimination, and calibration properties in predicting ICU mortality. Predictor variables were identified by reviewing relevant published studies from LMICs. The most frequently cited variables were selected to develop A Mortality Predictor Score (AMPS). Subsequently, the tool was assessed for accuracy, discrimination, and calibration using the Brier score, area under receiver operating characteristic curve (AUROC), reliability diagram and Decision curve analysis by using data gathered from the ICU of Black Lion Hospital between September 2019 and September 2020. Its prognostic ability was compared with the mortality prediction model II (MPM II) and ICU priority level. P p-value less than or equal to 0.05 was considered significant. The commonly identified model variables were Altered Mental status, Mechanical ventilation, More than two organ systems diagnosis, Pressure (systolic) less than 90, Potentially irreversible condition, Suspected infection, and Severe hypoalbuminemia (serum albumin <2 g/dl) (A(MPS)2. Each of these variables was found to be predictors of mortality when tested on 265 ICU patients admitted to the Adult Intensive Care Unit of Black Lion Hospital. A(MPS)2 was able to correctly predict mortality in 86.4% of the cases with a sensitivity of 87.6% and specificity of 84.6%. The area under the curve for the predictor scores was AMPS (Area 0.92; CI 0.88–0.93), MPM II score (Area 0.86; CI 0.82–0.91), and ICU priority level (Area 0.76; CI 0.68–0.83). AMPS is a promising prognostic score for ICU mortality in low-resource settings. External validation and comparison to other scores are needed.

Data availability

The data used in this study were obtained from pre-existing sources. Due to confidentiality and institutional restrictions, the supporting data are not publicly available. However, they can be provided upon reasonable request from the corresponding author, subject to relevant data-sharing policies.

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Acknowledgements

The authors would like to extend their acknowledgment to Addis Ababa University, the College of Health Sciences, for facilitating this research project and Dr. Obsie Temesgen for her valuable input during data collection and writing of the manuscript.

Funding

Not Applicable.

Author information

Authors and Affiliations

  1. College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia

    Finot Debebe, Lemlem Beza & Merahi Kefyalew Merahi

  2. St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

    Abate Yeshidinber Weldetsadik, Menbeu Sultan & Woldesenbet Waganew

  3. Departments of Anesthesia and Critical Care Medicine and Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Adam Laytin

  4. University of Toronto, Toronto, ON, Canada

    Alberto Goffi & Neill Adhikari

  5. New York Medical College, Metropolitan Hospital Center, New York, USA

    Getaw Hassen

  6. Africa Health Science University, Kigali, Rwanda

    Ayalew Zewdie & Emnet Tesfaye Shimber

  7. ALERT Comprehensive Specialized Hospital, Addis Ababa, Ethiopia

    Yared Firissa

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Contributions

G.H., M.S., and L.B. were responsible for patient data curation and initial data interpretation.M.K.M. and A.Z. wrote the main manuscript text.Y.F. and W.W. prepared Figs. 1, 2 and 3 and assisted with a statistical model.E.T. and N.A. critically reviewed and revised the manuscript for intellectual content.All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Merahi Kefyalew Merahi.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was conducted using secondary data, which was collected and analyzed without direct interaction with human participants. As such, it does not involve ethical concerns related to human subject research, including informed consent or direct patient involvement. The data was obtained from pre-existing sources(ICU logbooks), ensuring anonymity and confidentiality. Therefore, ethical approval was not required for this study.

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Not applicable. This study is based on secondary data analysis, and no identifiable personal information was used. Therefore, consent for publication is not required.

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Debebe, F., Weldetsadik, A.Y., Laytin, A. et al. Development and pilot testing of the AMPS model for predicting ICU mortality in low and middle income countries. Sci Rep (2026). https://doi.org/10.1038/s41598-026-41056-7

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  • Received: 09 July 2025

  • Accepted: 17 February 2026

  • Published: 26 February 2026

  • DOI: https://doi.org/10.1038/s41598-026-41056-7

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Keywords

  • ICU
  • Mortality
  • Low middle-income countries
  • predictor
  • score
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