Modified cardiovascular SOFA score in sepsis: development and internal and external validation

Abstract

Background The Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score. Methods We developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock. Results We identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p < 0.001), test set (0.716 vs 0.638), and all other cohorts (0.648 vs 0.557, 0.674 vs 0.589). Calibration was modest. In the suspected infection cohort, the modified model classified more patients to sepsis (66.0 vs 62.5%) and identified more patients at risk of septic mortality than the SOFA score (92.6 vs 89.5%). Conclusions Among ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.

Modified Cardiovascular Sequential Organ Failure Assessment Score in Sepsis: External Validation in Intensive Care Unit Patients

“…In the previous study, we demonstrated that newly developed modified CV/total SOFA score had higher predictive validity and calibration in ED patients with suspected infection, sepsis, and septic shock. 20 In this study, the same concept was applied to ICU patients, and the prognostic performance of modified CV/total SOFA score is better than that of the original scoring system, consistent with previous study.…”

“…With this background, we proposed the modified CV SOFA score using MAP, norepinephrine equivalent (NEq) dose ( Supplementary Table 1 ), and lactate in the previous multi-center, emergency department (ED) based study using suspected infection, sepsis, and septic shock cohorts. 20 We found that the modified CV/total SOFA score had better discrimination for 28-day mortality than the SOFA score and identified more patients at risk of septic mortality. In the present study, we externally validated the modified CV SOFA score in multi-center intensive care unit (ICU) patients with sepsis.…”

“…The SOFA score was calculated as described in the previous study using the worst value obtained during the 24 hours after ICU admission. 20 If variables were missing, including lactate and SOFA components, we imputed a normal value. The primary outcome was 28-day mortality after ICU admission.…”

Procalcitonin and interleukin-6 in predicting prognosis of sepsis patients with cancer

“…Sepsis is one of complications that seriously affect treatment success rate of patients admitted to intensive care unit(ICU) [1,2]. Patients suffering from sepsis are di cult to treat and have a high mortality rate.…”