Comparison of four scoring systems for predicting ICU mortality in patients with sepsis / 南方医科大学学报

OBJECTIVE@#To evaluate the value of Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score Ⅱ (SAPS-Ⅱ), Oxford Acute Severity of Illness Score (OASIS) and Logistic Organ Dysfunction System (LODS) scoring systems for predicting ICU mortality in patients with sepsis.@*METHODS@#We collected the data of a total of 2470 cases of sepsis recorded in the MIMIC-III database from 2001 to 2012 and retrieved the scores of SOFA, SAPS-Ⅱ, OASIS and LODS of the patients within the first day of ICU admission. We compared with the score between the survivors and the non-survivors and analyzed the differences in the area under the ROC curve (AUC) of the 4 scoring systems. Binomial logistic regression was performed to compare the predictive value of the 4 scoring systems for ICU mortality of the patients.@*RESULTS@#In the 2470 patients with sepsis, 1966 (79.6%) survived and 504 (20.4%) died in the ICU. Compared with the survivors, the non-survivors had a significantly older mean age, higher proportion of patients receiving mechanical ventilation, and higher initial lactate level, creatinine, urea nitrogen, SOFA score, SAPS-Ⅱ score, OASIS score and LODS score ( < 0.05) but with significantly lower body weight and platelet counts ( < 0.05). The AUCs of the SOFA score, SAPS-Ⅱ score, OASIS score, and LODS score were 0.729 ( < 0.001), 0.768 ( < 0.001), 0.757 ( < 0.001), and 0.739 ( < 0.001), respectively. The AUC of SAPS-Ⅱ score was significantly higher than those of SOFA score (=3.679, < 0.001) and LODS score (=3.698, < 0.001) but was comparable with that of OASIS score (=1.102, =0.271); the AUC of OASIS score was significantly higher than that of LODS score (=2.172, =0.030) and comparable with that of SOFA score (=1.709, =0.088). For predicting ICU mortality in patients without septic shock, the AUC of SAPS-Ⅱ score was 0.769 (0.743-0.793), the highest among the 4 scoring systems; in patients with septic shock, the AUCs SAPS-Ⅱ score and OASIS score, 0.768 (0.745-0.791) and 0.762 (0.738-0.785), respectively, were significantly higher than those of the other two scoring systems. Binomial logistic regression showed the corrected SOFA, SAPS-Ⅱ, and OASIS scores, but not LODS scores, were significantly correlated with ICU mortality in patients with sepsis, and their ORs were 1.08 (95% CI: 1.03-1.14, =0.001), 1.04 (95% CI: 1.02-1.05, < 0.001), 1.04 (95% CI: 1.01-1.06, =0.001), 0.96 (95% CI: 0.89-1.04, =0.350), respectively.@*CONCLUSIONS@#The scores of SOFA, SAPS-Ⅱ, OASIS, and LODS can predict ICU mortality in patients with sepsis, but SAPS-Ⅱ and OASIS scores have better predictive value than SOFA and LODS scores.

Predictive value of SOFA, qSOFA score and traditional evaluation index on sepsis prognosis / 中华危重病急救医学

Objective Assess the value of several biomarkers and disease severity scores for the prognostic assessment of sepsis.Methods The clinical data of adult patients, who met the diagnostic criteria for Sepsis-3 and admitted to the intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to December 2016 were retrospectively analyzed. These patients were divided into survival group and death group. The levels of serum lactate (Lac), lactate clearance rate of 24 hours later (24 h LCR), procalcitonin (PCT), quick sequential organ failure assessment (qSOFA) score, SOFA score, simplified acute physiology score Ⅱ (SAPS Ⅱ), acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) score were determined, and the receiver operating characteristic curve (ROC) were used to analyze the prognostic value of the indicators above.Results 110 of 152 sepsis patients survived, while the others died. Compared with survival group, serum Lac, PCT, SOFA score, qSOFA score, SAPS Ⅱ score, APACHE Ⅱ score of death group were increased, and 24 h LCR was decreased. SAPS Ⅱ[area under the ROC curve (AUC) = 0.877,P = 0.000, when threshold value was 41.50, sensitivity was 94.3%, specificity was 68.5%], 24 h LCR (AUC = 0.869,P = 0.000, when threshold value was 40.2%, sensitivity was 92.1%, specificity was 75.5%) and SOFA score (AUC = 0.815,P = 0.000, when threshold value was 7.60, sensitivity was 79.9%, specificity was 78.5%) showed better predictive value of sepsis. However, the predictive value of PCT (AUC = 0.759), Lac (AUC = 0.725), qSOFA (AUC = 0.701) and APACHE Ⅱ score (AUC = 0.680) were poorer (AUC = 0.6-0.8). For sepsis caused by abdominal cavity infection, the most accurate index was SOFA score (AUC = 0.889,P = 0.000, when threshold value was 9.50, sensitivity was 81.2%, specificity was 83.5%), and for sepsis caused by pneumonia, the most accurate index was PCT (AUC = 0.891,P = 0.001, when threshold value was 3.95 mg/L, sensitivity was 84.7%, specificity was 94.1%).Conclusion SOFA score and qSOFA score cannot take the place of traditional evaluation index for the evaluation of the prognosis of patients with sepsis.

Comparison of simplified acute physiology score Ⅲ and other scoring systems in prediction of 28-day ;prognosis in patients with severe sepsis / 中华危重病急救医学

Objective To investigate the power of the simplified acute physiology score Ⅲ ( SAPSⅢ) for prediction of outcome for patients with severe sepsis admitted to the intensive care unit ( ICU ). Methods A retrospective study was conducted. 677 severe sepsis patients with age ≥ 18 years old and the survival time in emergency ICU≥24 hours admitted to the emergency ICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2008 to December 2011 were enrolled. The acute physiology and chronic health evaluationⅡ ( APACHEⅡ), sequential organ failure assessment ( SOFA ), SAPSⅡ, SAPSⅢ, and mortality in emergency department sepsis ( MEDS ) scores were recorded based on the poorest value within 24 hours of ICU admission. The 28-day result as denoted as survival or death was considered as the end point of the study. The ability to predict mortality by the score systems was assessed by using receiver operating characteristic ( ROC ) curve analysis and binary logistic regression models. Results Among the 677 patients with severe sepsis, 284 cases died within 28 days after admission, and the mortality rate was 41.9%. Compared with survivors, the patients in non-survival group was older with higher APACHEⅡ, SOFA, SAPSⅡ, SAPSⅢ, and MEDS scores and higher ratio of underlying diseases, such as primary hypertension and renal dysfunction, and they had more organ injury, higher ratio of lung infection and bacterial infection ( P 0.05 ). The MEDS score in predicting the prognosis was obviously better than that of APACHEⅡ, SOFA, SAPSⅡ, and SAPSⅢscores ( all P<0.05 ). The MEDS score showed the best sensitivity ( 91.5%), and specificity ( 89.1%). The 28-day mortality in cases of MEDS≥11 was 85.8%. Conclusions ①For patients with severe sepsis who were admitted to ICU, MEDS was superior to APACHEⅡ, SOFA, SAPSⅡ, and SAPSⅢscores in predicting prognosis. MEDS≥11 may indicate a higher mortality rate.②SAPSⅢscore has comparable predictive capability with APACHEⅡ, SOFA and SAPSⅡscores may be recommended for prediction of the prognosis of patients with severe sepsis in ICU. But the SAPSⅢscore is unsuitable for predicting the prognosis of patients with acute sepsis in ICU options, and it is not superior to that of SAPSⅢscore in predicting prognosis of patients with sepsis in the emergency ICU than other score systems.

Application of the mortality in emergency department sepsis score for emergency department patients with sepsisi / 中华急诊医学杂志

ObjectiveTo assess the sepsis score used for detecting the mortality of patients with sepsis in emergency department, and to compare with APACHE Ⅱ score, simplified acute physiology Ⅱ score ( SAPS Ⅱ ) and modified early warning score (MEWS) in terms of 28-day mortality of patients. Methods A total of 613 patients with sepsis were enrolled from the emergency department for a prospective study from September 2009 to September 2010. The sepsis score, APACHE Ⅱ score, SAPS Ⅱ score and MEWS score all were recorded and compared. The patients with sepsis were followed up for 28 days. Based on the sepsis score, patients with sepsis were stratified into 5 mortality risk groups, namely very low risk group (0～4 points), low risk group (5 ～7 paints), moderate risk group (8 ～ 12 points), high risk group ( 13 ～ 15points) and very high risk group (more than 15 points). The actual mortality rates were compared among all 5 groups by using Chi square test. Then, comparison between survivors and non-survivors carried out with logistic regression analysis to determine the independent risk factors of mortality.Receiver operating characteristic curve (ROC curve) was used to compare the sepsis score with APACHE Ⅱ score, SAPS Ⅱscore and MEWS in respect of the prognosis validity. ResultsTen patients were out of the follow-up and the data of 603 patients followed up were completely documented. The actual mortality rates of 5 risk groups were 0％, 7.7％, 18.5％, 46. 7％ and 63％, respectively. There were significant differences in age and four scoring systems between survivors ( n = 440) and non-survivors ( n = 163 ) ( P ＜ 0. 01 ). Sepsis score,APACHE Ⅱ score, SAPS Ⅱ and MEWS all were valid and eligible for detecting the risk of mortality in patients with sepsis. The ROC areas under the curve (AUC) of these 4 scoring systems were 0. 767, 0. 743,0. 741 and 0. 636, respectively. ConclusionsThe sepsis score can be used to stratify patients with sepsis according to mortality risk with better sensitivity to predict 28-day mortality. It is rational for evaluation in prediction of patients with sepsis in Emergency Department.