A simple mortality prediction model for sepsis patients in intensive care
(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
- Koozi, Hazem LU ; Lidestam, Adina ; Lengquist, Maria LU ; Johnsson, Patrik LU and Frigyesi, Attila LU
- organization
- publishing date
- 2023
- 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
-
- scopus:85147528029
- pmid:37841294
- 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
- 2024-09-06 08:13:47
@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 < 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}}, }