Abstract
Background: Sepsis-induced coagulopathy (SIC) is a common cause for inducing poor prognosis of critically ill patients in intensive care unit (ICU). However, currently there are no tools specifically designed for assessing short-term mortality in SIC patients. This study aimed to develop a practical nomogram to predict the risk of 28-day mortality in SIC patients.Methods: In this retrospective cohort study, we extracted patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Sepsis was defined based on Sepsis 3.0 criteria and SIC based on Toshiaki Iba's criteria. Kaplan–Meier curves were plotted to compare the short survival time between SIC and non-SIC patients. Afterward, only SIC cohort was randomly divided into training or validation set. We employed univariate logistic regression and stepwise multivariate analysis to select predictive features. The proposed nomogram was developed based on multivariate logistic regression model, and the discrimination and calibration were verified by internal validation. We then compared model discrimination with other traditional severity scores and machine learning models.Results: 9432 sepsis patients in MIMIC III were enrolled, in which 3280 (34.8%) patients were diagnosed as SIC during the first ICU admission. SIC was independently associated with the 7- and 28-day mortality of ICU patients. K–M curve indicated a significant difference in 7-day (Log-Rank: P < 0.001 and P = 0.017) and 28-day survival (Log-Rank: P < 0.001 and P < 0.001) between SIC and non-SIC groups whether the propensity score match (PSM) was balanced or not. For nomogram development, a total of thirteen variables of 3,280 SIC patients were enrolled. When predicted the risk of 28-day mortality, the nomogram performed a good discrimination in training and validation sets (AUROC: 0.78 and 0.81). The AUROC values were 0.80, 0.81, 0.71, 0.70, 0.74, and 0.60 for random forest, support vector machine, sequential organ failure assessment (SOFA) score, logistic organ dysfunction score (LODS), simplified acute physiology II score (SAPS II) and SIC score, respectively, in validation set. And the nomogram calibration slope was 0.91, the Brier value was 0.15. As presented by the decision curve analyses, the nomogram always obtained more net benefit when compared with other severity scores.Conclusions: SIC is independently related to the short-term mortality of ICU patients. The nomogram achieved an optimal prediction of 28-day mortality in SIC patient, which can lead to a better prognostics assessment. However, the discriminative ability of the nomogram requires validation in external cohorts to further improve generalizability.
Highlights
Sepsis, defined as a dysregulated host response to infection by the Surviving Sepsis Campaign 2016 guideline, remains the leading cause of life-threatening organ dysfunction in the intensive care unit (ICU) [1]
To resolve the baseline imbalance problem, the sample was performed using the propensity score match (PSM), and we further explored the difference in short survival time between the sepsis-induced coagulopathy (SIC) and non-SIC patients
We unexpectedly found that the SIC patients were less likely to suffer from hypertension, chronic obstructive pulmonary disease (COPD), diabetes and myocardial infarction, but not liver disease, when compared with the nonSIC patients
Summary
Sepsis, defined as a dysregulated host response to infection by the Surviving Sepsis Campaign 2016 guideline, remains the leading cause of life-threatening organ dysfunction in the intensive care unit (ICU) [1]. The World Health Organization declared that the mortality of hospital-treated adult patients with sepsis is ∼189 per 100,000 person-years, and such a rate has been reported in up to 42% or even higher of ICUs depending on its severity in patients [2]. The clinical manifestations of such abnormalities range from thrombocytopenia during the initial phase to advanced disseminated intravascular coagulation, with the latter always leading to multiple organ dysfunction syndromes (MODS) and indicates higher mortality [4]. Sepsis-induced coagulopathy (SIC) is a common cause for inducing poor prognosis of critically ill patients in intensive care unit (ICU). This study aimed to develop a practical nomogram to predict the risk of 28-day mortality in SIC patients
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