scholarly journals Non-linear and Interaction Analyses of Biomarkers for Organ Dysfunctions as Predictive Markers for Sepsis: A Nationwide Retrospective Study

2022 ◽  
Vol 12 (1) ◽  
pp. 44
Author(s):  
Yutaka Umemura ◽  
Kazuma Yamakawa ◽  
Shuhei Murao ◽  
Yumi Mitsuyama ◽  
Hiroshi Ogura ◽  
...  
Keyword(s):  
Sofa Score ◽  
Prognostic Value ◽  
Large Scale ◽  
Odds Ratios ◽  
Modified Method ◽  
Prognostic Accuracy ◽  
Weak Association ◽  
Failure Assessment ◽  
Prognostic Association ◽  
Organ Dysfunctions

The Sequential Organ Failure Assessment (SOFA) score is predominantly used to assess the severity of organ dysfunction in sepsis. However, differences in prognostic value between SOFA subscores have not been sufficiently evaluated. This retrospective observational study used a large-scale database containing about 30 million patients. Among them, we included 38,869 adult patients with sepsis from 2006 to 2019. The cardiovascular and neurological subscores were calculated by a modified method. Associations between the biomarkers of the SOFA components and mortality were examined using restricted cubic spline analyses, which showed that an increase in the total modified SOFA score was linearly associated with increased mortality. However, the prognostic association of subscores varied widely: platelet count showed a J-shaped association, creatinine showed an inverted J-shaped association, and bilirubin showed only a weak association. We also evaluated interaction effects on mortality between an increase of one subscore and another. The joint odds ratios on mortality of two modified SOFA subscores were synergistically increased compared to the sum of the single odds ratios, especially in cardiovascular-neurological, coagulation-hepatic, and renal-hepatic combinations. In conclusion, total modified SOFA score was associated with increased mortality despite the varied prognostic associations of the subscores, possibly because interactions between subscores synergistically enhanced prognostic accuracy.

scholarly journals Non-Linear And Cross-Interaction Analyses of SOFA Subscores As Predictive Markers For Sepsis: A Nationwide Retrospective Study

2021 ◽  
Author(s):  
Yutaka Umemura ◽  
Kazuma Yamakawa ◽  
Shuhei Murao ◽  
Yumi Mitsuyama ◽  
Hiroshi Ogura ◽  
...  
Keyword(s):  
Sofa Score ◽  
Large Scale ◽  
Interaction Effects ◽  
Study Cohort ◽  
Odds Ratios ◽  
Suspected Infection ◽  
Prognostic Accuracy ◽  
Non Linear ◽  
Almost All ◽  
Prognostic Association

Abstract Background: The Sequential Organ Failure Assessment (SOFA) score is predominantly used to assess the severity of organ dysfunction in sepsis and is definitely proved to be associated with mortality. However, differences in prognostic value between SOFA subscores have not been sufficiently evaluated so far, and detailed evaluation of subscores is required to verify the clinical significance of the SOFA score. The present study aimed to evaluate the non-linear prognostic association of SOFA subscores and the cross-interaction effects on mortality when SOFA subscores were simultaneously increased.Methods: This retrospective observational study used a part of a large-scale database containing about 30 million patients. Among them, we included all adult patients requiring unplanned hospital admission and were diagnosed as having sepsis by Sepsis-3 criteria from February 2006 to December 2019. A proven/suspected infection was defined as having any of the ICD-10 codes for infection. Associations between the SOFA components and in-hospital mortality were examined using linear and non-linear logistic regression analyses. We also evaluated two-way interaction effects on mortality between an increase of one SOFA subscore and another.Results: The final study cohort included 38,869 patients with sepsis. Restricted cubic spline analyses showed that an increase in total SOFA score was sharply and linearly associated with increased mortality. However, the prognostic association of SOFA subscores was non-linear and varied widely by biomarker: platelet count showed a J-shaped association, creatinine showed an inverted J-shaped association, and bilirubin showed only a weak association with mortality. The mortality odds ratios of SOFA scores were synergistically increased when another SOFA subscore was higher than 2 points, and the effect modifications were statistically significant in almost all subgroups. Especially in patients with cardiovascular or hepatic subscores of ≥ 2 points, odds ratios of the other SOFA subscores were remarkably increased (double to triple) compared to those in the whole study population.Conclusion: Despite the widely varied prognostic associations of SOFA subscores, total SOFA score was sharply and almost linearly associated with increased mortality. Cross-interactions between subscores synergistically enhanced its prognostic associations and might be responsible for the high prognostic accuracy of the total SOFA score.

scholarly journals Prognostic Accuracy of QSOFA Score Compared to SOFA Score among Patients with Sepsis

2021 ◽  
Vol 10 (41) ◽  
pp. 3557-3561
Author(s):  
Hamsa B.T. ◽  
Srinivas S.V. ◽  
Prabhakar K. ◽  
Maharaj L.S.Y.M. J ◽  
Raveesha A.
Keyword(s):  
Mortality Rate ◽  
Sofa Score ◽  
Scoring System ◽  
Prospective Observational Study ◽  
Ventilator Support ◽  
Mortality And Morbidity ◽  
Prognostic Accuracy ◽  
Failure Assessment ◽  
Life Threatening ◽  
Qsofa Score

BACKGROUND Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. According to sepsis - 3 criteria, sepsis is diagnosed by Sequential organ failure assessment (SOFA) score of more than two. Surviving sepsis campaign introduced a newer scoring system, quick SOFA (QSOFA) score which uses only clinical parameters to prognosticate sepsis bed side and at the earliest. The purpose of this study was to evaluate the QSOFA score and then compare it to SOFA score in prognostication of sepsis. METHODS This study was a prospective observational study conducted in R. L. Jalappa Hospital among 150 individuals. Assessment of SOFA and QSOFA score was done and its significance in predicting mortality and morbidity was compared. RESULTS There were 87 males and 63 females. Mortality rate was 38.7 %. The initial QSOFA score of 1, 2 and 3 had mortality rate of 5.2 %, 24.1 % and 70.7 % respectively. Initial SOFA score of < 4, 4 - 8 and > 8 had mortality rate of 5.2 %, 37.9 % and 56.9 % respectively. Interpretation - The SOFA score had statistically significant correlation in assessing need for ventilator support, QSOFA score had a significant relation assessing need for ventilator support, vasopressor support. CONCLUSIONS Both scores demonstrated good accuracy for predicting in-hospital mortality. The QSOFA scoring system can aid where the resources are limited. KEY WORDS Sepsis, SOFA Score, QSOFA Score, Septic Shock

Prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA)-lactate criteria for mortality in adults with suspected bacterial infection in the emergency department of a hospital with limited resources

2020 ◽  
Vol 37 (6) ◽  
pp. 363-369 ◽  
Author(s):  
Robert Sinto ◽  
Suhendro Suwarto ◽  
Khie Chen Lie ◽  
Kuntjoro Harimurti ◽  
Djoko Widodo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Bacterial Infection ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Lactate Concentration ◽  
Limited Resources ◽  
Screening Criteria ◽  
Prognostic Accuracy ◽  
Failure Assessment

BackgroundRoutine use of the Sequential Organ Failure Assessment (SOFA) score to prognosticate patients with sepsis is challenged by the requirement to perform numerous laboratory tests. The prognostic accuracy of the quick SOFA (qSOFA) without or with lactate criteria has not been prospectively investigated in low and middle income countries. We assessed the performance of simplified prognosis criteria using qSOFA-lactate criteria in the emergency department of a hospital with limited resources, in comparison with SOFA prognosis criteria and systemic inflammatory response syndrome (SIRS) screening criteria.MethodsThis prospective cohort study was conducted between March and December 2017 in adult patients with suspected bacterial infection visiting the emergency department of the Indonesian National Referral Hospital. Variables from sepsis prognosis and screening criteria and venous lactate concentration at enrolment were recorded. Patients were followed up until hospital discharge or death. Prognostic accuracy was measured using area under the receiver operating characteristic curve (AUROC) of each criterion in the prediction of in-hospital mortality.ResultsOf 3026 patients screened, 1213 met the inclusion criteria. The AUROC of qSOFA-lactate criteria was 0.74 (95% CI 0.71 to 0.77). The AUROC of qSOFA-lactate was not statistically significantly different to the SOFA score (AUROC 0.75, 95% CI 0.72 to 0.78; p=0.462). The qSOFA-lactate was significantly higher than qSOFA (AUROC 0.70, 95% CI0.67 to 0.74; p=0.006) and SIRS criteria (0.57, 95% CI0.54 to 0.60; p<0.001).ConclusionsThe prognostic accuracy of the qSOFA-lactate criteria is as good as the SOFA score in the emergency department of a hospital with limited resources. The performance of the qSOFA criteria is significantly lower than the qSOFA-lactate criteria and SOFA score.This abstract has been translated and adapted from the original English-language content. Translated content is provided on an "as is" basis. Translation accuracy or reliability is not guaranteed or implied. BMJ is not responsible for any errors and omissions arising from translation to the fullest extent permitted by law, BMJ shall not incur any liability, including without limitation, liability for damages, arising from the translated text.

scholarly journals Prospective longitudinal observational study in assessing prognostic accuracy of sequential organ failure assessment and quick-sequential organ failure assessment scores in detecting morbidity and mortality in critically ill children

2021 ◽  
Vol 8 (10) ◽  
pp. 1684
Author(s):  
Naresh Kumar N. ◽  
Suresh Chelliah D. ◽  
Senguttuvan D.
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Critically Ill ◽  
Sofa Score ◽  
Morbidity And Mortality ◽  
Critically Ill Children ◽  
Assessment Score ◽  
Prognostic Accuracy ◽  
Failure Assessment ◽  
Sick Children

Background: The objective of the study was to assess prognostic accuracy of SOFA (sequential organ failure assessment score) and Q-SOFA (quick-sequential organ failure assessment) score in detecting morbidity and mortality in critically ill children admitted in our intensive care unit.Methods: All critically ill children admitted were recruited over a time period of 7 months. Q-SOFA score was assessed at presentation, followed by SOFA score on day 1 and day 2 of ICU stay and outcome was observed.Results: Total of 272 sick children were recruited and assessed. All eight (2.94%) mortalities had high Q-SOFA score of three (p<0.001), mean SOFA (day 1) score 11.12±0.99 (p<0.001), mean SOFA (day 2) was 11.62±1.40 (p<0.001).Conclusions: Q-SOFA is a simple, inexpensive and rapid test to assess and predict sick children requiring ICU care in emergency department. High SOFA score predicts high probability of mortality and detects organ failure early.

scholarly journals Large-scale pan-cancer analysis reveals broad prognostic association between TGF-β ligands, not Hedgehog, and GLI1/2 expression in tumors

2019 ◽  
Author(s):  
Aurélien de Reyniès ◽  
Delphine Javelaud ◽  
Nabila Elarouci ◽  
Véronique Marsaud ◽  
Cristèle Gilbert ◽  
...  
Keyword(s):  
Similar Pattern ◽  
Prognostic Value ◽  
Large Scale ◽  
Activating Mutations ◽  
Pathway Activation ◽  
Frequent Failure ◽  
Tumor Types ◽  
Pan Cancer ◽  
Prognostic Association ◽  
Transcriptional Target

AbstractGLI1 expression is broadly accepted as a marker of Hedgehog pathway activation in tumors. Efficacy of Hedgehog inhibitors is essentially limited to tumors bearing activating mutations of the pathway. GLI2, a critical Hedgehog effector, is necessary for GLI1 expression and is a direct transcriptional target of TGF-β/SMAD signaling. We examined the expression correlations of GLI1/2 with TGFB and HH genes in 152 distinct transcriptome datasets totaling over 23,500 patients and representing 37 types of neoplasms. Their prognostic value was measured in over 15,000 clinically annotated tumor samples from 26 tumor types. In most tumor types, GLI1 and GLI2 follow a similar pattern of expression and are equally correlated with HH and TGFB genes. However, GLI1/2 broadly share prognostic value with TGFB genes and a mesenchymal/EMT signature, not with HH genes. Our results provide a likely explanation for the frequent failure of anti-Hedgehog therapies in tumors, as they suggest a key role for TGF-β, not Hedgehog, ligands, in tumors with elevated GLI1/2-expression.

scholarly journals Prognostic biomarkers in predicting mortality in respiratory patients with ventilator-associated pneumonia

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nermeen A. Abdelaleem ◽  
Hoda A. Makhlouf ◽  
Eman M. Nagiub ◽  
Hassan A. Bayoumi
Keyword(s):  
Sofa Score ◽  
Diagnostic Performance ◽  
Mortality Prediction ◽  
Ventilator Associated Pneumonia ◽  
Distribution Width ◽  
Mechanically Ventilated ◽  
Neutrophil Lymphocyte Ratio ◽  
Prognostic Accuracy ◽  
Severity Scores ◽  
Critical Patients

Abstract Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection. Red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) are prognostic factors to mortality in different diseases. The aim of this study is to evaluate prognostic efficiency RDW, NLR, and the Sequential Organ Failure Assessment (SOFA) score for mortality prediction in respiratory patients with VAP. Results One hundred thirty-six patients mechanically ventilated and developed VAP were included. Clinical characteristics and SOFA score on the day of admission and at diagnosis of VAP, RDW, and NLR were assessed and correlated to mortality. The average age of patients was 58.80 ± 10.53. These variables had a good diagnostic performance for mortality prediction AUC 0.811 for SOFA at diagnosis of VAP, 0.777 for RDW, 0.728 for NLR, and 0.840 for combined of NLR and RDW. The combination of the three parameters demonstrated excellent diagnostic performance (AUC 0.889). A positive correlation was found between SOFA at diagnosis of VAP and RDW (r = 0.446, P < 0.000) and with NLR (r = 0.220, P < 0.010). Conclusions NLR and RDW are non-specific inflammatory markers that could be calculated quickly and easily via routine hemogram examination. These markers have comparable prognostic accuracy to severity scores. Consequently, RDW and NLR are simple, yet promising markers for ICU physicians in monitoring the clinical course, assessment of organ dysfunction, and predicting mortality in mechanically ventilated patients. Therefore, this study recommends the use of blood biomarkers with the one of the simplest ICU score (SOFA score) in the rapid diagnosis of critical patients as a daily works in ICU.

scholarly journals Establishment of a prognostic model based on the Sequential Organ Failure Assessment score for patients with first-time acute myocardial infarction

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110119
Author(s):  
Shuai Zheng ◽  
Jun Lyu ◽  
Didi Han ◽  
Fengshuo Xu ◽  
Chengzhuo Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Cardiovascular Events ◽  
Failure Assessment ◽  
First Time

Objective This study aimed to identify the prognostic factors of patients with first-time acute myocardial infarction (AMI) and to establish a nomogram for prognostic modeling. Methods We studied 985 patients with first-time AMI using data from the Multi-parameter Intelligent Monitoring for Intensive Care database and extracted their demographic data. Cox proportional hazards regression was used to examine outcome-related variables. We also tested a new predictive model that includes the Sequential Organ Failure Assessment (SOFA) score and compared it with the SOFA-only model. Results An older age, higher SOFA score, and higher Acute Physiology III score were risk factors for the prognosis of AMI. The risk of further cardiovascular events was 1.54-fold higher in women than in men. Patients in the cardiac surgery intensive care unit had a better prognosis than those in the coronary heart disease intensive care unit. Pressurized drug use was a protective factor and the risk of further cardiovascular events was 1.36-fold higher in nonusers. Conclusion The prognosis of AMI is affected by age, the SOFA score, the Acute Physiology III score, sex, admission location, type of care unit, and vasopressin use. Our new predictive model for AMI has better performance than the SOFA model alone.

scholarly journals SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

2021 ◽  
Vol 11 (3) ◽  
pp. 164
Author(s):  
Mahmoud Al-Obeidallah ◽  
Dagmar Jarkovská ◽  
Lenka Valešová ◽  
Jan Horák ◽  
Jan Jedlička ◽  
...  
Keyword(s):  
Septic Shock ◽  
Body Temperature ◽  
Sofa Score ◽  
Porcine Model ◽  
Venous Blood ◽  
Mixed Venous Blood ◽  
Mechanically Ventilated ◽  
Multiple Parameters ◽  
Failure Assessment ◽  
Sepsis And Septic Shock

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

scholarly journals 414. Association of SARS-CoV-2 Genomic Load Trends with Clinical Status in COVID-19:A Retrospective Analysis from an Academic Hospital Center in New York City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S275-S275
Author(s):  
Ioannis Zacharioudakis ◽  
Fainareti Zervou ◽  
Prithiv Prasad ◽  
Yongzhao Shao ◽  
Atreyee Basu ◽  
...  
Keyword(s):  
New York ◽  
Sofa Score ◽  
Research Question ◽  
Clinical Status ◽  
Inverse Correlation ◽  
Duration Of Symptoms ◽  
Cycle Threshold ◽  
Ct Value ◽  
Failure Assessment ◽  
Polymerase Chain

Abstract Background The Infectious Diseases Society of America has identified the potential use of SARS-CoV-2 genomic load for prognostication purposes as a key research question. Methods We designed a retrospective cohort study that included adult patients with COVID-19 pneumonia who had at least 2 positive nasopharyngeal tests at least 24 hours apart to study the correlation between the change in the genomic load of SARS-CoV-2 in nasopharyngeal samples, as reflected by the Cycle threshold (Ct) value of the real-time Polymerase Chain Reaction (PCR) assay, with change in clinical status. The Sequential Organ Failure Assessment (SOFA) score was used as a surrogate for patients’ clinical status. A linear mixed-effects regression analysis was performed. Results Among 457 patients who presented to the emergency department between 3/31/2020- 4/10/2020, we identified 42 patients who met the inclusion criteria. The median initial SOFA score was 2 (IQR 2–3). 20 out of 42 patients had a lower SOFA score on their subsequent tests. We identified a statistically significant inverse correlation between the change in SOFA score and change in the Ct value with a decrease in SOFA score by 0.05 (SE 0.02; p &lt; 0.05) for an increase in Ct values by 1. This correlation was independent of the duration of symptoms. Flow chart A graph of the Cycle Threshold (Ct) values of the of Cepheid Xpert® Xpress SARS-CoV-2 assay measured on repeat screening of the 42 included patients. Graph of the fitted SOFA scores based on the Cycle Threshold values per patient. Conclusion Our findings suggest that an increasing Ct value in sequential tests may be of prognostic value for patients diagnosed with COVID-19 pneumonia. Before repeat testing can be recommended routinely in clinical practice as a predictor of disease outcomes, prospective studies with a standardized interval between repeat tests should confirm our findings. Disclosures All Authors: No reported disclosures

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