Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS
(2020) In PLoS ONE 15(2).- Abstract
Background To allow early identification of patients at risk of sepsis in the emergency department (ED), a variety of risk stratification scores and/or triage systems are used. The first aim of this study was to develop a risk stratification score for sepsis based upon vital signs and biomarkers using a statistical approach. Second, we aimed to validate the Rapid Emergency Triage and Treatment System (RETTS) for sepsis. RETTS combines vital signs with symptoms for risk stratification. Methods We retrospectively analysed data from two prospective, observational, multicentre cohorts of patients from studies of biomarkers in ED. A candidate risk stratification score called Sepsis Heparin-binding protein-based Early Warning Score (SHEWS)... (More)
Background To allow early identification of patients at risk of sepsis in the emergency department (ED), a variety of risk stratification scores and/or triage systems are used. The first aim of this study was to develop a risk stratification score for sepsis based upon vital signs and biomarkers using a statistical approach. Second, we aimed to validate the Rapid Emergency Triage and Treatment System (RETTS) for sepsis. RETTS combines vital signs with symptoms for risk stratification. Methods We retrospectively analysed data from two prospective, observational, multicentre cohorts of patients from studies of biomarkers in ED. A candidate risk stratification score called Sepsis Heparin-binding protein-based Early Warning Score (SHEWS) was constructed using the Least Absolute Shrinkage and Selector Operator (LASSO) method. SHEWS and RETTS were compared to National Early Warning Score 2 (NEWS2) for infection-related organ dysfunction, intensive care or death within the first 72h after admission (i.e. sepsis). Results 506 patients with a diagnosed infection constituted cohort A, in which SHEWS was derived and RETTS was validated. 435 patients constituted cohort B of whom 184 had a diagnosed infection where both scores were validated. In both cohorts (A and B), AUC for infection-related organ dysfunction, intensive care or death was higher for NEWS2, 0.80 (95% CI 0.76–0.84) and 0.69 (95% CI 0.63–0.74), than RETTS, 0.74 (95% CI 0.70–0.79) and 0.55 (95% CI 0.49–0.60), p = 0.05 and p <0.01, respectively. SHEWS had the highest AUC, 0.73 (95% CI 0.68–0.79) p = 0.32 in cohort B. Conclusions Even with a statistical approach, we could not construct better risk stratification scores for sepsis than NEWS2. RETTS was inferior to NEWS2 for screening for sepsis.
(Less)
- author
- Mellhammar, Lisa LU ; Linder, Adam LU ; Tverring, Jonas LU ; Christensson, Bertil LU ; Boyd, John H. ; Åkesson, Per LU and Kahn, Fredrik LU
- organization
- publishing date
- 2020-02-20
- type
- Contribution to journal
- publication status
- published
- subject
- in
- PLoS ONE
- volume
- 15
- issue
- 2
- article number
- e0229210
- publisher
- Public Library of Science (PLoS)
- external identifiers
-
- scopus:85079682858
- pmid:32078640
- ISSN
- 1932-6203
- DOI
- 10.1371/journal.pone.0229210
- language
- English
- LU publication?
- yes
- id
- a65a0cae-b612-4cdb-bc1a-2fe8e025a320
- date added to LUP
- 2020-03-04 15:11:44
- date last changed
- 2024-05-29 10:33:50
@article{a65a0cae-b612-4cdb-bc1a-2fe8e025a320, abstract = {{<p>Background To allow early identification of patients at risk of sepsis in the emergency department (ED), a variety of risk stratification scores and/or triage systems are used. The first aim of this study was to develop a risk stratification score for sepsis based upon vital signs and biomarkers using a statistical approach. Second, we aimed to validate the Rapid Emergency Triage and Treatment System (RETTS) for sepsis. RETTS combines vital signs with symptoms for risk stratification. Methods We retrospectively analysed data from two prospective, observational, multicentre cohorts of patients from studies of biomarkers in ED. A candidate risk stratification score called Sepsis Heparin-binding protein-based Early Warning Score (SHEWS) was constructed using the Least Absolute Shrinkage and Selector Operator (LASSO) method. SHEWS and RETTS were compared to National Early Warning Score 2 (NEWS2) for infection-related organ dysfunction, intensive care or death within the first 72h after admission (i.e. sepsis). Results 506 patients with a diagnosed infection constituted cohort A, in which SHEWS was derived and RETTS was validated. 435 patients constituted cohort B of whom 184 had a diagnosed infection where both scores were validated. In both cohorts (A and B), AUC for infection-related organ dysfunction, intensive care or death was higher for NEWS2, 0.80 (95% CI 0.76–0.84) and 0.69 (95% CI 0.63–0.74), than RETTS, 0.74 (95% CI 0.70–0.79) and 0.55 (95% CI 0.49–0.60), p = 0.05 and p <0.01, respectively. SHEWS had the highest AUC, 0.73 (95% CI 0.68–0.79) p = 0.32 in cohort B. Conclusions Even with a statistical approach, we could not construct better risk stratification scores for sepsis than NEWS2. RETTS was inferior to NEWS2 for screening for sepsis.</p>}}, author = {{Mellhammar, Lisa and Linder, Adam and Tverring, Jonas and Christensson, Bertil and Boyd, John H. and Åkesson, Per and Kahn, Fredrik}}, issn = {{1932-6203}}, language = {{eng}}, month = {{02}}, number = {{2}}, publisher = {{Public Library of Science (PLoS)}}, series = {{PLoS ONE}}, title = {{Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS}}, url = {{http://dx.doi.org/10.1371/journal.pone.0229210}}, doi = {{10.1371/journal.pone.0229210}}, volume = {{15}}, year = {{2020}}, }