Identifying which septic patients have increased mortality risk using severity scores: a cohort study

BMC Anesthesiology

Charis A Marwick¹  Bruce Guthrie¹  Jan EC Pringle³  Shaun R McLeod⁴  Josie MM Evans²  Peter G Davey¹ 

[1] Population Health Sciences Division, Medical Research Institute, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK

[2] University of Stirling, School of Nursing, Midwifery and Health, R G Bomont Building, Stirling FK9 4LA, UK

[3] School of Health and Life Sciences, K415 Buchanan House, Glasgow Caledonian University, Glasgow G4 0BA, UK

[4] Department of Anaesthesia, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK

关键词: SIRS;    Systemic inflammatory response syndrome;    CURB65;    CURB;    Mortality;    Outcomes;    Risk scores;    Severity;    Sepsis;   

Others  :  816634
DOI  :  10.1186/1471-2253-14-1

 received in 2013-10-03, accepted in 2013-12-18,  发布年份 2014

【 摘 要 】

Background

Early aggressive therapy can reduce the mortality associated with severe sepsis but this relies on prompt recognition, which is hindered by variation among published severity criteria. Our aim was to test the performance of different severity scores in predicting mortality among a cohort of hospital inpatients with sepsis.

Methods

We anonymously linked routine outcome data to a cohort of prospectively identified adult hospital inpatients with sepsis, and used logistic regression to identify associations between mortality and demographic variables, clinical factors including blood culture results, and six sets of severity criteria. We calculated performance characteristics, including area under receiver operating characteristic curves (AUROC), of each set of severity criteria in predicting mortality.

Results

Overall mortality was 19.4% (124/640) at 30 days after sepsis onset. In adjusted analysis, older age (odds ratio 5.79 (95% CI 2.87-11.70) for ≥80y versus <60y), having been admitted as an emergency (OR 3.91 (1.31-11.70) versus electively), and longer inpatient stay prior to sepsis onset (OR 2.90 (1.41-5.94) for >21d versus <4d), were associated with increased 30 day mortality. Being in a surgical or orthopaedic, versus medical, ward was associated with lower mortality (OR 0.47 (0.27-0.81) and 0.26 (0.11-0.63), respectively). Blood culture results (positive vs. negative) were not significantly association with mortality. All severity scores predicted mortality but performance varied. The CURB65 community-acquired pneumonia severity score had the best performance characteristics (sensitivity 81%, specificity 52%, positive predictive value 29%, negative predictive value 92%, for 30 day mortality), including having the largest AUROC curve (0.72, 95% CI 0.67-0.77).

Conclusions

The CURB65 pneumonia severity score outperformed five other severity scores in predicting risk of death among a cohort of hospital inpatients with sepsis. The utility of the CURB65 score for risk-stratifying patients with sepsis in clinical practice will depend on replicating these findings in a validation cohort including patients with sepsis on admission to hospital.

【 授权许可】

   
2014 Marwick et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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