The Performance of Sepsis-3 Criteria to Predict Mortality among patients with hematologic malignancy and post-transplant who have Suspected Infection

Abstract Background Sepsis is a leading cause of death, particularly in immunocompromised people. The revised definition of sepsis (Sepsis-3) uses Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) to identify patients with sepsis. The aim of this study was to evaluate the performance of SOFA, qSOFA and SIRS (systemic inflammatory response syndrome) in immunocompromised patients. Methods Adult immunocompromised patients admitted to Michigan Medicine between 2012-2018 with suspected infection were included based on criteria adopted from the Sepsis-3 study. Each clinical score (SOFA≥2, qSOFA≥2, SIRS≥2) was added to the baseline risk model as an ordinal as well as dichotomous variables and AUROC values were calculated. In addition, breakpoints of SOFA between 2-10 were assessed to identify the breakpoints with the highest sensitivity and specificity for hospital mortality. The analysis was stratified for intensive care unit (ICU) status. Results Of 2822 immunocompromised patients with a mean age of 56.8±15.6, 213 (7.5%) died during hospitalization. When added to the baseline risk model, SOFA score had the greatest predictive validity for hospital mortality [AUROC=0.802 (95%CI: 0.771-0.832)], followed by qSOFA (AUROC=0.783 (0.754-0.812) and SIRS (AUROC=0.741 (0.708-0.774]). Among SOFA breakpoints that were evaluated, SOFA≥6 had the greatest predictive validity and moderate positive likelihood ratio (2.75) for hospital mortality. Conclusion The predictive validity for hospital mortality of qSOFA was similar among immunocompromised patients to that reported in the Sepsis-3 study. The sensitivity of qSOFA≥2 for hospital mortality was low. SOFA≥6 might be an effective tool to identify immunocompromised patients with suspected infection at high risk for clinical deterioration.

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223. Predicting Mortality Among Immunocompromised Patients Who Present With Bloodstream Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.298 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S130-S130

Author(s):

Oryan Henig ◽

Krishna Rao ◽

Rosemary KB Putler ◽

Twisha S Patel ◽

Owen Albin ◽

...

Keyword(s):

Bloodstream Infection ◽

Risk Model ◽

Hematologic Malignancy ◽

Solid Organ Transplantation ◽

Baseline Risk ◽

Solid Organ ◽

Immunocompromised Patients ◽

Suspected Infection ◽

Dichotomous Variable ◽

Definition Of

Abstract Background The revised definition of sepsis (Sepsis-3) uses Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) to identify patients with sepsis instead of systemic inflammatory response syndrome (SIRS) criteria. Subsequent studies revealed contradictory results pertaining to qSOFA, and limited data are available for immunocompromised patients. The objectives of this study were to (1) evaluate the performance of Sepsis -3 in a cohort of immunocompromised patients with microbiologically-proven sepsis, defined as having received antibiotics and having bloodstream infection (BSI); and (2) to compare its performance in the BSI cohort to its performance in immunocompromised patients who received antibiotics but did not have BSI (Non-BSI cohort). Methods Adult patients with hematologic malignancy or solid transplant recipients admitted to Michigan Medicine between 2012–2017 with suspected infection were included based on criteria used in the Sepsis-3 study: having both a body fluid culture and having received intravenous antibiotics. SOFA, qSOFA and SIRS components within 1 day of the index date (culture date or antibiotic date, whichever came first) were extracted from the medical record. For each group, a baseline risk model for mortality was created including age, gender, race, and Charlson comorbidity index. Each score (SOFA ≥ 2, qSOFA ≥ 2, SIRS ≥ 2) was added to the baseline risk model as a dichotomous variable and AUROC values were calculated. Results 2822 patients with a mean age of 56.8±15.6 were included. 349 (12.4%) had BSI. The most common immune compromising conditions were solid-organ transplantation (47%), lymphoma (21.3%) and acute leukemia (17%). 14% of patients in the BSI cohort died during hospitalization compared with 6.6% in the non-BSI cohort (P < 0.001). For the BSI cohort, when SOFA ≥ 2, qSOFA ≥ 2, SIRS ≥ 2 scores were added to the model, the AUROC values were less than those for the non-BSI cohort (table). The addition of SOFA ≥6 to the baseline risk model produced the highest AUROC values in both the BSI and non-BSI cohorts (figure). Conclusion Among immunocompromised patients, an SOFA score ≥6 was the strongest predictor of mortality. Surprisingly, sepsis scores performed better in the non-BSI cohort than in the BSI cohort. Disclosures All authors: No reported disclosures.

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The Comparison between Sepsis 1.0 and Sepsis 3.0 in Database of Severe Infection in Critical Illness: A Retrospective Study

10.21203/rs.2.10225/v1 ◽

2019 ◽

Author(s):

Wei Zhang ◽

Yan Zheng ◽

Juan Gu ◽

Yan Kang

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Sequential Organ Failure Assessment ◽

Critically Ill ◽

Predictive Validity ◽

Critically Ill Patients ◽

Severe Infection ◽

Suspected Infection ◽

Failure Assessment

Abstract Objective To compared the Sepsis 1.0 criterial with the Sepsis 3.0 criteria predict the efficacy of all-caused mortality of in-hospital in critically ill patients with severe infection. Design This is a retrospective and cohort study based on the database of severe infection. Setting A 48-bed general intensive care unit in affiliated hospital of University. Patients Critically ill patients with suspected infection based on the electronic health records from 1 January to 31 December, 2015. Interventions None. Measurements The variables of exposures included: quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS) score and sequential organ failure assessment (SOFA). Main outcomes and measures: for predictive validity, we found that the discrimination for hospital mortality was more common with sepsis than with uncomplicated infections. Results are reported as the area under the receiver operating characteristic curve (AUROC).Main Results In the primary cohort, 873 patients had suspected infection cohort (n=634), of whom 188 (29.7%) died; and with the non-infection cohort (n=239), 26 patients died (10.9%). Among intensive care unit (ICU) cases in the infection cohort, the predictive validity for hospital mortality was higher for Sepsis 3.0 (SOFA) criteria (AUROC=0.702; 95%CI, 0.665 −0.737; p≤0.01 for both) than for Sepsis 1.0 (SIRS) criteria (AUROC=0.533; 95% confidence interval [95%CI], 0.493−0.572). Conclusions In our study, we found the Sepsis 3.0 criteria is able to accurately predict the prognosis in critically ill patients with severe infection, and its predictive efficacy is superior to Sepsis 1.0 criteria.

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Predictive Validity of the qSOFA Score for Sepsis in Adults with Community-Onset Staphylococcal Infection in Thailand

Journal of Clinical Medicine ◽

10.3390/jcm8111908 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1908 ◽

Cited By ~ 2

Author(s):

Supaksh Gupta ◽

Kristina E. Rudd ◽

Sarunporn Tandhavanant ◽

Pornpan Suntornsut ◽

Ploenchan Chetchotisakd ◽

...

Keyword(s):

Predictive Validity ◽

Risk Model ◽

Secondary Analysis ◽

Culture Collection ◽

Staphylococcal Infection ◽

Baseline Risk ◽

Multivariable Logistic Regression Model ◽

Middle Income ◽

Qsofa Score ◽

Community Onset

The quick sequential organ failure assessment (qSOFA) score has had limited validation in lower resource settings and was developed using data from high-income countries. We sought to evaluate the predictive validity of the qSOFA score for sepsis within a low- and middle-income country (LMIC) population with culture-proven staphylococcal infection. This was a secondary analysis of a prospective multicenter cohort in Thailand with culture-positive infection due to Staphylococcus aureus or S. argenteus within 24 h of admission and positive (≥2/4) systemic inflammatory response syndrome (SIRS) criteria. Primary exposure was maximum qSOFA score within 48 h of culture collection and primary outcome was mortality at 28 days. Baseline risk of mortality was determined using a multivariable logistic regression model with age, gender, and co-morbidities significantly associated with the outcome. Predictive validity was assessed by discrimination of mortality using area under the receiver operating characteristic (AUROC) curve compared to a model using baseline risk factors alone. Of 253 patients (mean age 54 years (SD 16)) included in the analysis, 23 (9.1%) died by 28 days after enrollment. Of those who died, 0 (0%) had a qSOFA score of 0, 8 (35%) had a score of 1, and 15 (65%) had a score ≥2. The AUROC of qSOFA plus baseline risk was significantly greater than for the baseline risk model alone (AUROCqSOFA = 0.80 (95% CI, 0.70–0.89), AUROCbaseline = 0.62 (95% CI, 0.49–0.75); p < 0.001). Among adults admitted to four Thai hospitals with community-onset coagulase-positive staphylococcal infection and SIRS, the qSOFA score had good predictive validity for sepsis.

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The Utility of the Rapid Emergency Medicine Score (REMS) compared with SIRS, qSOFA and NEWS for predicting in-Hospital Mortality Among Patients with Suspicion of Sepsis in an Emergency Department

10.21203/rs.3.rs-52232/v1 ◽

2020 ◽

Author(s):

Onlak Ruangsomboon ◽

Phetsinee Boonmee ◽

Chok Limsuwat ◽

Tipa Chakorn ◽

Apichaya Monsomboon

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Hospital Mortality ◽

Early Warning ◽

Risk Model ◽

Adverse Outcomes ◽

Early Warning Score ◽

Baseline Risk ◽

Secondary Outcome ◽

Net Benefit

Abstract Background Many early warning scores (EWSs) have been validated to prognosticate adverse outcomes secondary to sepsis in the Emergency Department (ED). These EWSs include the Systemic Inflammatory Response Syndrome criteria (SIRS), the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score (NEWS). However, the Rapid Emergency Medicine Score (REMS) has never been validated for this purpose. We aimed to assess and compare the prognostic utility of REMS with that of SIRS, qSOFA and NEWS for predicting mortality in patients with suspicion of sepsis in the ED.Methods We conducted a retrospective study at the ED of Siriraj Hospital Mahidol University, Thailand. Adult patients suspected of having sepsis in the ED between August 2018 and July 2019 were included. Their EWSs were calculated. The primary outcome was all-cause in-hospital mortality. The secondary outcome was 7-day mortality.Results A total of 1622 patients were included in the study; 574 (28.2%) died at hospital discharge. REMS yielded the highest discrimination capacity for in-hospital mortality (the area under the receiver operator characteristics curves (AUROC) 0.62 (95% confidence interval (CI) 0.59, 0.65)), which was significantly higher than qSOFA (AUROC 0.58 (95%CI 0.55, 0.60); p=0.005) and SIRS (AUROC 0.52 (95%CI 0.49, 0.55); p<0.001) but not significantly superior to NEWS (AUROC 0.61 (95%CI 0.58, 0.64); p=0.27). REMS was the best EWS in terms of calibration and association with the outcome. It could also provide the highest net benefit from the decision curve analysis. Comparison of EWSs plus baseline risk model showed similar results. REMS also performed better than other EWSs for 7-day mortality.ConclusionREMS was an early warning score with higher accuracy than sepsis-related scores (qSOFA and SIRS) and had the highest utility in terms of net benefit compared to SIRS, qSOFA and NEWS in predicting in-hospital mortality in patients presenting to the ED with suspected sepsis.

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The utility of the rapid emergency medicine score (REMS) compared with SIRS, qSOFA and NEWS for Predicting in-hospital Mortality among Patients with suspicion of Sepsis in an emergency department

BMC Emergency Medicine ◽

10.1186/s12873-020-00396-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Onlak Ruangsomboon ◽

Phetsinee Boonmee ◽

Chok Limsuwat ◽

Tipa Chakorn ◽

Apichaya Monsomboon

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Hospital Mortality ◽

Early Warning ◽

Risk Model ◽

Adverse Outcomes ◽

Early Warning Score ◽

Baseline Risk ◽

Secondary Outcome ◽

Net Benefit

Abstract Background Many early warning scores (EWSs) have been validated to prognosticate adverse outcomes secondary to sepsis in the Emergency Department (ED). These EWSs include the Systemic Inflammatory Response Syndrome criteria (SIRS), the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score (NEWS). However, the Rapid Emergency Medicine Score (REMS) has never been validated for this purpose. We aimed to assess and compare the prognostic utility of REMS with that of SIRS, qSOFA and NEWS for predicting mortality in patients with suspicion of sepsis in the ED. Methods We conducted a retrospective study at the ED of Siriraj Hospital Mahidol University, Thailand. Adult patients suspected of having sepsis in the ED between August 2018 and July 2019 were included. Their EWSs were calculated. The primary outcome was all-cause in-hospital mortality. The secondary outcome was 7-day mortality. Results A total of 1622 patients were included in the study; 457 (28.2%) died at hospital discharge. REMS yielded the highest discrimination capacity for in-hospital mortality (the area under the receiver operator characteristics curves (AUROC) 0.62 (95% confidence interval (CI) 0.59, 0.65)), which was significantly higher than qSOFA (AUROC 0.58 (95%CI 0.55, 0.60); p = 0.005) and SIRS (AUROC 0.52 (95%CI 0.49, 0.55); p < 0.001) but not significantly superior to NEWS (AUROC 0.61 (95%CI 0.58, 0.64); p = 0.27). REMS was the best EWS in terms of calibration and association with the outcome. It could also provide the highest net benefit from the decision curve analysis. Comparison of EWSs plus baseline risk model showed similar results. REMS also performed better than other EWSs for 7-day mortality. Conclusion REMS was an early warning score with higher accuracy than sepsis-related scores (qSOFA and SIRS), similar to NEWS, and had the highest utility in terms of net benefit compared to SIRS, qSOFA and NEWS in predicting in-hospital mortality in patients presenting to the ED with suspected sepsis.

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Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy

Heart ◽

10.1136/heartjnl-2018-313439 ◽

2018 ◽

Vol 105 (4) ◽

pp. 330-336 ◽

Cited By ~ 3

Author(s):

Veerle Dam ◽

N Charlotte Onland-Moret ◽

W M Monique Verschuren ◽

Jolanda M A Boer ◽

Laura Benschop ◽

...

Keyword(s):

Risk Model ◽

Model Performance ◽

Predictive Performance ◽

Baseline Risk ◽

Hypertensive Disorders Of Pregnancy ◽

Cvd Risk ◽

Hypertensive Disorders ◽

Framingham Risk ◽

History Of ◽

Score Model

ObjectivesCompare the predictive performance of Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs) and Systematic COronary Risk Evaluation (SCORE) model between women with and without a history of hypertensive disorders of pregnancy (hHDP) and determine the effects of recalibration and refitting on predictive performance.MethodsWe included 29 751 women, 6302 with hHDP and 17 369 without. We assessed whether models accurately predicted observed 10-year cardiovascular disease (CVD) risk (calibration) and whether they accurately distinguished between women developing CVD during follow-up and not (discrimination), separately for women with and without hHDP. We also recalibrated (updating intercept and slope) and refitted (recalculating coefficients) the models.ResultsOriginal FRS and PCEs overpredicted 10-year CVD risks, with expected:observed (E:O) ratios ranging from 1.51 (for FRS in women with hHDP) to 2.29 (for PCEs in women without hHDP), while E:O ratios were close to 1 for SCORE. Overprediction attenuated slightly after recalibration for FRS and PCEs in both hHDP groups. Discrimination was reasonable for all models, with C-statistics ranging from 0.70-0.81 (women with hHDP) and 0.72–0.74 (women without hHDP). C-statistics improved slightly after refitting 0.71–0.83 (with hHDP) and 0.73–0.80 (without hHDP). The E:O ratio of the original PCE model was statistically significantly better in women with hHDP compared with women without hHDP.ConclusionsSCORE performed best in terms of both calibration and discrimination, while FRS and PCEs overpredicted risk in women with and without hHDP, but improved after recalibrating and refitting the models. No separate model for women with hHDP seems necessary, despite their higher baseline risk.

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Italian hospital mortality risk model vs additive and logistic EuroSCORE in coronary operations

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2008.10.031 ◽

2009 ◽

Vol 35 (2) ◽

pp. 379-380 ◽

Cited By ~ 1

Author(s):

Marco Ranucci

Keyword(s):

Hospital Mortality ◽

Mortality Risk ◽

Risk Model ◽

Logistic Euroscore ◽

Italian Hospital

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A risk-model for hospital mortality among patients with severe sepsis or septic shock based on German national administrative claims data

PLoS ONE ◽

10.1371/journal.pone.0194371 ◽

2018 ◽

Vol 13 (3) ◽

pp. e0194371 ◽

Cited By ~ 6

Author(s):

Daniel Schwarzkopf ◽

Carolin Fleischmann-Struzek ◽

Hendrik Rüddel ◽

Konrad Reinhart ◽

Daniel O. Thomas-Rüddel

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Hospital Mortality ◽

Claims Data ◽

Risk Model ◽

Administrative Claims ◽

Administrative Claims Data

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A Combination of Chest Radiography and Estimated Plasma Volume May Predict In-Hospital Mortality in Acute Heart Failure

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.752915 ◽

2022 ◽

Vol 8 ◽

Author(s):

Masatake Kobayashi ◽

Amine Douair ◽

Stefano Coiro ◽

Gaetan Giacomin ◽

Adrien Bassand ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Natriuretic Peptide ◽

Plasma Volume ◽

Risk Model ◽

Hospital Death ◽

Pulmonary Congestion ◽

Patients With Heart Failure ◽

High Prediction ◽

Score Index

Background: Patients with heart failure (HF) often display dyspnea associated with pulmonary congestion, along with intravascular congestion, both may result in urgent hospitalization and subsequent death. A combination of radiographic pulmonary congestion and plasma volume might screen patients with a high risk of in-hospital mortality in the emergency department (ED).Methods: In the pathway of dyspneic patients in emergency (PARADISE) cohort, patients admitted for acute HF were stratified into 4 groups based on high or low congestion score index (CSI, ranging from 0 to 3, high value indicating severe congestion) and estimated plasma volume status (ePVS) calculated from hemoglobin/hematocrit.Results: In a total of 252 patients (mean age, 81.9 years; male, 46.8%), CSI and ePVS were not correlated (Spearman rho <0 .10, p > 0.10). High CSI/high ePVS was associated with poorer renal function, but clinical congestion markers (i.e., natriuretic peptide) were comparable across CSI/ePVS categories. High CSI/high ePVS was associated with a four-fold higher risk of in-hospital mortality (adjusted-OR, 95%CI = 4.20, 1.10-19.67) compared with low CSI/low ePVS, whereas neither high CSI nor ePVS alone was associated with poor prognosis (all-p-value > 0.10; Pinteraction = 0.03). High CSI/high ePVS improved a routine risk model (i.e., natriuretic peptide and lactate)(NRI = 46.9%, p = 0.02), resulting in high prediction of risk of in-hospital mortality (AUC = 0.85, 0.82-0.89).Conclusion: In patients hospitalized for acute HF with relatively old age and comorbidity burdens, a combination of CSI and ePVS was associated with a risk of in-hospital death, and improved prognostic performance on top of a conventional risk model.

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