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Derivation of Novel Risk Prediction Scores for Community-Acquired Sepsis and Severe Sepsis.

ABSTRACT: We sought to derive and internally validate a Sepsis Risk Score and a Severe Sepsis Risk Score predicting future sepsis and severe sepsis events among community-dwelling adults.National population-based cohort.United States.A total of 30,239 community-dwelling adults 45 years old or older in the national REasons for Geographic And Racial Differences in Stroke cohort.None.Over a median of 6.6 years (interquartile range, 5.1-8.1 yr) of follow-up, there were 1,532 first sepsis (prevalence 8.3 per 1,000 person-years) and 1,151 first severe sepsis (6.2 per 1,000 person-years) events. Risk factors in the best derived Sepsis Risk Score and Severe Sepsis Risk Score included chronic lung disease, age 75 years or older, peripheral artery disease, diabetes, tobacco use, white race, stroke, atrial fibrillation, coronary artery disease, obesity, hypertension, deep vein thrombosis, male sex, high-sensitivity C-reactive protein greater than 3.0?mg/dL, cystatin C ?1.11?mg/dL, estimated glomerular filtration rate less than 60?mL/min/1.73 m, and albumin-to-creatinine ratio protein greater than 30 ?g/mg. Sepsis Risk Score risk categories were very low (0-3 points; 2.3 events per 1,000 person-years), low (4-6; 4.1), medium (7-9; 6.5), high (10-12; 9.7), and very high (13-38; 21.1). Severe Sepsis Risk Score risk categories were very low (0-5 points; 1.5 events per 1,000 person-years), low (6-9; 3.4), medium (10-13; 6.7), high (14-17; 9.9), and very high (18-45; 22.1). The Sepsis Risk Score and Severe Sepsis Risk Score exhibited good discrimination (bootstrapped C index, 0.703 and 0.742) and calibration (p = 0.65 and 0.06).The Sepsis Risk Score and Severe Sepsis Risk Score predict 10-year sepsis and severe sepsis risk among community-dwelling adults and may aid in sepsis prevention or mitigation efforts.

SUBMITTER: Wang HE

PROVIDER: S-EPMC4911244 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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Derivation of Novel Risk Prediction Scores for Community-Acquired Sepsis and Severe Sepsis.

Wang Henry E HE Donnelly John P JP Griffin Russell R Levitan Emily B EB Shapiro Nathan I NI Howard George G Safford Monika M MM

Critical care medicine 20160701 7

<h4>Objective</h4>We sought to derive and internally validate a Sepsis Risk Score and a Severe Sepsis Risk Score predicting future sepsis and severe sepsis events among community-dwelling adults.<h4>Design</h4>National population-based cohort.<h4>Setting</h4>United States.<h4>Subjects</h4>A total of 30,239 community-dwelling adults 45 years old or older in the national REasons for Geographic And Racial Differences in Stroke cohort.<h4>Interventions</h4>None.<h4>Measurements and main results</h4> ...[more]

PMID: 27031381

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Project description:Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis hospitalizations in a national hospital sample.Retrospective analysis of severe sepsis discharges from University HealthSystem Consortium hospitals in 2012.United States.We used the criteria from Angus et al (discharge diagnoses for both a serious infection and organ dysfunction) to identify severe sepsis hospitalizations. We defined healthcare-associated severe sepsis as severe sepsis hospitalizations with an infection present at admission, where the patient was a nursing home resident, was on hemodialysis, or was readmitted within 30 days of a prior hospitalization. We defined community-acquired severe sepsis as all other severe sepsis patients with an infection present at admission. We defined hospital-acquired severe sepsis as severe sepsis patients where the documented infection was not present at admission.None.Prevalence of community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis, adjusted hospital mortality, length of hospitalization, length of stay in an ICU, and hospital costs. Among 3,355,753 hospital discharges, there were 307,491 with severe sepsis, including 193,081 (62.8%) community-acquired severe sepsis, 79,581 (25.9%) healthcare-associated severe sepsis, and 34,829 (11.3%) hospital-acquired severe sepsis. Hospital-acquired severe sepsis and healthcare-associated severe sepsis exhibited higher in-hospital mortality than community-acquired severe sepsis (hospital acquired [19.2%] vs healthcare associated [12.8%] vs community acquired [8.6%]). Hospital-acquired severe sepsis had greater resource utilization than both healthcare-associated severe sepsis and community-acquired severe sepsis, with higher median length of hospital stay (hospital acquired [17 d] vs healthcare associated [7 d] vs community acquired [6 d]), median length of ICU stay (hospital acquired [8 d] vs healthcare associated [3 d] vs community acquired [3 d]), and median hospital costs (hospital acquired [$38,369] vs healthcare associated [$8,796] vs community acquired [$7,024]).In this series, severe sepsis hospitalizations included community-acquired severe sepsis (62.8%), healthcare-associated severe sepsis (25.9%), and hospital-acquired severe sepsis (11.3%) cases. Hospital-acquired severe sepsis was associated with both higher mortality and resource utilization than community-acquired severe sepsis and healthcare-associated severe sepsis.

Project description:BackgroundGlobally there are over 1,400 cases of pneumonia per 100,000 children every year, where children in South Asia and Sub-Saharan Africa are disproportionately affected. Some of the cases develop poor treatment outcome (treatment failure or antibiotic change or staying longer in the hospital or death), while others develop good outcome during interventions. Although clinical decision-making is a key aspect of the interventions, there are limited tools such as risk scores to assist the clinical judgment in low-income settings. This study aimed to validate a prediction model and develop risk scores for poor outcomes of severe community-acquired pneumonia (SCAP).MethodsA cohort study was conducted among 539 under-five children hospitalized with SCAP. Data analysis was done using R version 4.0.5 software. A multivariable analysis was done. We developed a simplified risk score to facilitate clinical utility. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plot. Bootstrapping was used to validate all accuracy measures. A decision curve analysis was used to evaluate the clinical and public health utility of our model.ResultsThe incidence of poor outcomes of pneumonia was 151(28%) (95%CI: 24.2%-31.8%). Vaccination status, fever, pallor, unable to breastfeed, impaired consciousness, CBC abnormal, entered ICU, and vomiting remained in the reduced model. The AUC of the original model was 0.927, 95% (CI (0.90, 0.96), whereas the risk score model produced prediction accuracy of an AUC of 0.89 (95%CI: 0.853-0.922. Our decision curve analysis for the model provides a higher net benefit across ranges of threshold probabilities.ConclusionsOur model has excellent discrimination and calibration performance. Similarly, the risk score model has excellent discrimination and calibration ability with an insignificant loss of accuracy from the original. The models can have the potential to improve care and treatment outcomes in the clinical settings.

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Derivation of Novel Risk Prediction Scores for Community-Acquired Sepsis and Severe Sepsis.

Publications

Derivation of Novel Risk Prediction Scores for Community-Acquired Sepsis and Severe Sepsis.

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