Analysis of the correlation between the longitudinal trajectory of SOFA scores and prognosis in patients with sepsis at 72 hour after admission based on group trajectory modeling

Abstract

BackgroundTo identify the distinct trajectories of the Sequential Organ Failure Assessment (SOFA) scores at 72 h for patients with sepsis in the Medical Information Mart for Intensive Care (MIMIC)-IV database and determine their effects on mortality and adverse clinical outcomes. MethodsA retrospective cohort study was carried out involving patients with sepsis from the MIMIC-IV database. Group-based trajectory modeling (GBTM) was used to identify the distinct trajectory groups for the SOFA scores in patients with sepsis in the intensive care unit (ICU). The Cox proportional hazards regression model was used to investigate the relationship between the longitudinal change trajectory of the SOFA score and mortality and adverse clinical outcomes. ResultsA total of 16,743 patients with sepsis were included in the cohort. The median survival age was 66 years (interquartile range: 54–76 years). The 7-day and 28-day in-hospital mortality were 6.0% and 17.6%, respectively. Five different trajectories of SOFA scores according to the model fitting standard were determined: group 1 (32.8%), group 2 (30.0%), group 3 (17.6%), group 4 (14.0%) and group 5 (5.7%). Univariate and multivariate Cox regression analyses showed that, for different clinical outcomes, trajectory group 1 was used as the reference, while trajectory groups 2–5 were all risk factors associated with the outcome (P < 0.001). Subgroup analysis revealed an interaction between the two covariates of age and mechanical ventilation and the different trajectory groups of patients’ SOFA scores (P < 0.05). ConclusionThis approach may help identify various groups of patients with sepsis, who may be at different levels of risk for adverse health outcomes, and provide subgroups with clinical importance.