Early prediction of septic shock in hospitalized patients

Abstract

BACKGROUND:Hospitalized patients who develop severe sepsis have significant morbidity and mortality. Early goal‐directed therapy has been shown to decrease mortality in severe sepsis and septic shock, though a delay in recognizing impending sepsis often precludes this intervention.OBJECTIVE:To identify early predictors of septic shock among hospitalized non‐intensive care unit (ICU) medical patients.DESIGN:Retrospective cohort analysis.SETTING:A 1200‐bed academic medical center.PATIENTS:Derivation cohort consisted of 13,785 patients hospitalized during 2005. The validation cohorts consisted of 13,737 patients during 2006 and 13,937 patients from 2007.INTERVENTION:Development and prospective validation of a prediction model using Recursive Partitioning And Regression Tree (RPART) analysis.METHODS:RPART analysis of routine laboratory and hemodynamic variables from the derivation cohort to identify predictors prior to the occurrence of shock. Two models were generated, 1 including arterial blood gas (ABG) data and 1 without.RESULTS:When applied to the 2006 cohort, 347 (54.7%) and 121 (19.1%) of the 635 patients developing septic shock were correctly identified by the 2 models, respectively. For the 2007 patients, the 2 models correctly identified 367 (55.0%) and 102 (15.3%) of the 667 patients developing septic shock, respectively.CONCLUSIONS:Readily available data can be employed to predict non‐ICU patients who develop septic shock several hours prior to ICU admission. Journal of Hospital Medicine 2010;5:19–25. © 2010 Society of Hospital Medicine.

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

“…Other studies use additional threshold such as SBP (71), and a lactic acid concentration >2 mmol/L (72,73). Two studies employed recursive partitioning tree analysis involving a variety of variables such as shock index, mean arterial blood pressure, international normalized ratio (INR), white blood cell (WBC) count, absolute neutrophil count, bilirubin, albumin, hemoglobin and sodium (74,75). One high-quality RCT, however, failed to identify any beneficial effect of this alerting system on patient-important outcomes (67).…”

Can a Computerized Sepsis Screening and Alert System Accurately Diagnose Sepsis in Hospitalized Floor Patients and Potentially Provide Opportunities for Early Intervention? A Pilot Study

“…Kollef et al was the first to report on the development of an electronic sepsis detection system for floor patients [25,26]. Our algorithm performs well compared to theirs.…”

Diagnostic Performance of Electronic Syndromic Surveillance Systems in Acute Care

“…Twenty-five studies involved academic institutions, three involved community hospitals and five studies were performed in a mixed community and academic setting. A thematic abundance of ESS systems was identified, covering a wide spectrum of clinical areas encompassing acute lung injury [13][14][15], patient-ventilator interaction [16][17][18], identification of seizures [19], rapid patient deterioration [20] nosocomial infection surveillance [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], heart failure [36], life-threatening electrocardiographic changes [37][38][39] and hemodynamic stability monitoring [40][41][42].…”