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A simple mortality prediction model for sepsis patients in intensive care

Koozi, Hazem LU ; Lidestam, Adina ; Lengquist, Maria LU orcid ; Johnsson, Patrik LU and Frigyesi, Attila LU (2023) In Journal of the Intensive Care Society 24(4). p.372-378
Abstract

Background: Sepsis is common in the intensive care unit (ICU). Two of the ICU’s most widely used mortality prediction models are the Simplified Acute Physiology Score 3 (SAPS-3) and the Sequential Organ Failure Assessment (SOFA) score. We aimed to assess the mortality prediction performance of SAPS-3 and SOFA upon ICU admission for sepsis and find a simpler mortality prediction model for these patients to be used in clinical practice and when conducting studies. Methods: A retrospective study of adult patients fulfilling the Sepsis-3 criteria admitted to four general ICUs was performed. A simple prognostic model was created using backward stepwise multivariate logistic regression. The area under the curve (AUC) of SAPS-3, SOFA and the... (More)

Background: Sepsis is common in the intensive care unit (ICU). Two of the ICU’s most widely used mortality prediction models are the Simplified Acute Physiology Score 3 (SAPS-3) and the Sequential Organ Failure Assessment (SOFA) score. We aimed to assess the mortality prediction performance of SAPS-3 and SOFA upon ICU admission for sepsis and find a simpler mortality prediction model for these patients to be used in clinical practice and when conducting studies. Methods: A retrospective study of adult patients fulfilling the Sepsis-3 criteria admitted to four general ICUs was performed. A simple prognostic model was created using backward stepwise multivariate logistic regression. The area under the curve (AUC) of SAPS-3, SOFA and the simple model was assessed. Results: One thousand nine hundred eighty four admissions were included. A simple six-parameter model consisting of age, immunosuppression, Glasgow Coma Scale, body temperature, C-reactive protein and bilirubin had an AUC of 0.72 (95% confidence interval (CI) 0.69–0.75) for 30-day mortality, which was non-inferior to SAPS-3 (AUC 0.75, 95% CI 0.72–0.77) (p = 0.071). SOFA had an AUC of 0.67 (95% CI 0.64–0.70) and was inferior to SAPS-3 (p < 0.001) and our simple model (p = 0.0019). Conclusion: SAPS-3 has a lower prognostic value in sepsis than in the general ICU population. SOFA performs less well than SAPS-3. Our simple six-parameter model predicts mortality just as well as SAPS-3 upon ICU admission for sepsis, allowing the design of simple studies and performance monitoring.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Critical care, Intensive care units, Mortality, Prognosis, Risk adjustment, Sepsis
in
Journal of the Intensive Care Society
volume
24
issue
4
pages
372 - 378
publisher
SAGE Publications
external identifiers
  • pmid:37841294
  • scopus:85147528029
ISSN
1751-1437
DOI
10.1177/17511437221149572
project
SweCrit, a critical care biobank
language
English
LU publication?
yes
additional info
Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: HK is funded by Kristianstad Central Hospital, Department of Anaesthesia and Intensive Care. AF is funded by governmental grants for clinical research within the National Health Services (ALF YF). Publisher Copyright: © The Intensive Care Society 2023.
id
d0e15d7d-cde1-4cba-88cb-20870f087ec2
date added to LUP
2023-02-15 23:34:29
date last changed
2024-06-14 00:06:33
@article{d0e15d7d-cde1-4cba-88cb-20870f087ec2,
  abstract     = {{<p>Background: Sepsis is common in the intensive care unit (ICU). Two of the ICU’s most widely used mortality prediction models are the Simplified Acute Physiology Score 3 (SAPS-3) and the Sequential Organ Failure Assessment (SOFA) score. We aimed to assess the mortality prediction performance of SAPS-3 and SOFA upon ICU admission for sepsis and find a simpler mortality prediction model for these patients to be used in clinical practice and when conducting studies. Methods: A retrospective study of adult patients fulfilling the Sepsis-3 criteria admitted to four general ICUs was performed. A simple prognostic model was created using backward stepwise multivariate logistic regression. The area under the curve (AUC) of SAPS-3, SOFA and the simple model was assessed. Results: One thousand nine hundred eighty four admissions were included. A simple six-parameter model consisting of age, immunosuppression, Glasgow Coma Scale, body temperature, C-reactive protein and bilirubin had an AUC of 0.72 (95% confidence interval (CI) 0.69–0.75) for 30-day mortality, which was non-inferior to SAPS-3 (AUC 0.75, 95% CI 0.72–0.77) (p = 0.071). SOFA had an AUC of 0.67 (95% CI 0.64–0.70) and was inferior to SAPS-3 (p &lt; 0.001) and our simple model (p = 0.0019). Conclusion: SAPS-3 has a lower prognostic value in sepsis than in the general ICU population. SOFA performs less well than SAPS-3. Our simple six-parameter model predicts mortality just as well as SAPS-3 upon ICU admission for sepsis, allowing the design of simple studies and performance monitoring.</p>}},
  author       = {{Koozi, Hazem and Lidestam, Adina and Lengquist, Maria and Johnsson, Patrik and Frigyesi, Attila}},
  issn         = {{1751-1437}},
  keywords     = {{Critical care; Intensive care units; Mortality; Prognosis; Risk adjustment; Sepsis}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{372--378}},
  publisher    = {{SAGE Publications}},
  series       = {{Journal of the Intensive Care Society}},
  title        = {{A simple mortality prediction model for sepsis patients in intensive care}},
  url          = {{http://dx.doi.org/10.1177/17511437221149572}},
  doi          = {{10.1177/17511437221149572}},
  volume       = {{24}},
  year         = {{2023}},
}