Evaluation of evolving sepsis screening criteria in discriminating suspected sepsis and mortality among adult patients admitted to the intensive care unit

Abstract

BackgroundInstitutions struggle with successful use of sepsis alerts within electronic health records. ObjectiveTest the association of sepsis screening measurement criteria in discrimination of mortality and detection of sepsis in a large dataset. DesignRetrospective, cohort study using a large United States (U.S.) intensive care database. The Institutional Review Board exempt status was obtained from Kansas University Medical Center Human Research Protection Program (10-1-2015). Setting334 U.S. hospitals participating in the eICU Research Institute. ParticipantsNine hundred twelve thousand five hundred and nine adult intensive care admissions from 183 hospitals. MethodsExposures included: systemic inflammatory response syndrome criteria ≥ 2 (Sepsis-1); systemic inflammatory response syndrome criteria with organ failure criteria ≥ 3.5 points (Sepsis-2); and sepsis-related organ failure assessment score ≥ 2 and quick score ≥ 2 (Sepsis-3). Discrimination of outcomes was determined with/without (adjusted/unadjusted) baseline risk exposure to a model. The receiver operating characteristic curve (AUROC) and odds ratios (ORs) for each decile of baseline risk of sepsis or death were assessed. ResultsWithin the eligible cohort of 912,509, a total of 86,219 (9.4 %) patients did not survive their hospital stay and 186,870 (20.5 %) met the definition of suspected sepsis. For suspected sepsis discrimination, Sepsis-2 (unadjusted AUROC 0.67, 99 % CI: 0.66–0.67 and adjusted AUROC 0.77, 99 % CI: 0.77–0.77) outperformed Sepsis-3 (SOFA unadjusted AUROC 0.61, 99 % CI: 0.61–0.61 and adjusted AUROC 0.74, 99 % CI: 0.74–0.74) (qSOFA unadjusted AUROC 0.59, 99 % CI: 0.59–0.60 and adjusted AUROC 0.73, 99 % CI: 0.73–0.73). Sepsis-2 also outperformed Sepsis-1 (unadjusted AUROC 0.58, 99 % CI: 0.58–0.58 and adjusted AUROC 0.73, 99 % CI: 0.73–0.73). In between differences of AUROCs were statistically significantly different. Sepsis-2 ORs were higher for the outcome of suspected sepsis when considering deciles of risk than the other measurement systems. Conclusions and relevanceSepsis-2 outperformed other systems in suspected sepsis detection and was comparable to SOFA in prognostic accuracy of mortality in adult intensive care patients.