Abstract
BackgroundEarly and accurate identification of septic patients at high risk for ICU mortality can help clinicians make optimal clinical decisions and improve the patients’ outcomes. This study aimed to develop and validate (internally and externally) a mortality prediction score for sepsis following admission in the ICU.MethodsWe extracted data retrospectively regarding adult septic patients from one teaching hospital in Wenzhou, China and a large multi-center critical care database from the USA. Demographic data, vital signs, laboratory values, comorbidities, and clinical outcomes were collected. The primary outcome was ICU mortality. Through multivariable logistic regression, a mortality prediction score for sepsis was developed and validated.ResultsFour thousand two hundred and thirty six patients in the development cohort and 8359 patients in three validation cohorts. The Prediction of Sepsis Mortality in ICU (POSMI) score included age ≥ 50 years, temperature < 37 °C, Respiratory rate > 35 breaths/min, MAP ≤ 50 mmHg, SpO2 < 90%, albumin ≤ 2 g/dL, bilirubin ≥ 0.8 mg/dL, lactate ≥ 4.2 mmol/L, BUN ≥ 21 mg/dL, mechanical ventilation, hepatic failure and metastatic cancer. In addition, the area under the receiver operating characteristic curve (AUC) for the development cohort was 0.831 (95% CI, 0.813–0.850) while the AUCs ranged from 0.798 to 0.829 in the three validation cohorts. Moreover, the POSMI score had a higher AUC than both the SOFA and APACHE IV scores. Notably, the Hosmer–Lemeshow (H–L) goodness-of-fit test results and calibration curves suggested good calibration in the development and validation cohorts. Additionally, the POSMI score still exhibited excellent discrimination and calibration following sensitivity analysis. With regard to clinical usefulness, the decision curve analysis (DCA) of POSMI showed a higher net benefit than SOFA and APACHE IV in the development cohort.ConclusionPOSMI was validated to be an effective tool for predicting mortality in ICU patients with sepsis.
Highlights
And accurate identification of septic patients at high risk for Intensive Care Unit (ICU) mortality can help clinicians make optimal clinical decisions and improve the patients’ outcomes
Several predictive systems have been developed to date, including the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV scores [5, 6], Simplified Acute Physiology Score (SAPS) II and III [7, 8], Sequential Organ Failure Assessment (SOFA) score [4], Predisposition, Insult/Infection, Response and Organ Dysfunction (PIRO) [9] and the Charlson comorbidity index [10]
The infection sites most frequently associated with sepsis were pulmonary (41%), renal/urinary tract infection (UTI) (23%), GI (13%), unknown (10%), cutaneous/soft tissue (8%) and others (4%)
Summary
And accurate identification of septic patients at high risk for ICU mortality can help clinicians make optimal clinical decisions and improve the patients’ outcomes. Several predictive systems have been developed to date, including the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV scores [5, 6], Simplified Acute Physiology Score (SAPS) II and III [7, 8], Sequential Organ Failure Assessment (SOFA) score [4], Predisposition, Insult/Infection, Response and Organ Dysfunction (PIRO) [9] and the Charlson comorbidity index [10] These scores have been applied widely in a variety of patient groups, especially those who are critically ill, they may exhibit poor sensitivity or/ and specificity and low reproducibility when applied to some specific diseases [11]. There are currently no risk prediction systems available for septic patients
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