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Scores for sepsis detection and risk stratification – construction of a novel score using a statistical approach and validation of RETTS

Mellhammar, Lisa LU ; Linder, Adam LU ; Tverring, Jonas LU orcid ; Christensson, Bertil LU ; Boyd, John H. ; Åkesson, Per LU and Kahn, Fredrik LU (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.

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organization
publishing date
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 &lt;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}},
}