The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria

Gadrey, Shrirang M; Clay, Russ; Zimmet, Alex; Lawson, Alexander; Oliver, Samuel F.; Richardson, Emily D.; Forrester, Vernon J.; Andris, Robert T; Rhodes, Garret T.; Voss, John D.; Moore, Christopher C.; Moorman, J. Randall

doi:10.1097/cce.0000000000000199

Cited by 7 publications

(9 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our cohort, SOFA Acute greater than or equal to 2 also was associated with increased mortality. Mortality was low in the cohort analyzed by Gadrey et al ( 5 ), that is, pretest probability was lower than in our cohort. Consequently, following Fagan’s nomogram, the apparent performance of the SOFA score is worse, despite similar likelihood ratios.…”

Section: Discussioncontrasting

confidence: 70%

“…By using SOFA not adjusted for chronic organ failures, the prognostic value of the sepsis definition may have been exaggerated in the large epidemiological studies where the differentiation between acute and chronic organ failures could not be made. In assessing mortality in patients with SOFA greater than or equal to 2 either due to total SOFA or acute SOFA only, Gadrey et al ( 5 ) found that only the prior was significantly associated with increased mortality. In our cohort, SOFA Acute greater than or equal to 2 also was associated with increased mortality.…”

Section: Discussionmentioning

confidence: 99%

“…However, little is known about the relative impact of chronic and acute organ failures. The sole study addressing this question found that acute organ failures causing SOFA greater than or equal to 2 were in fact not associated with increased mortality, in contrast to the corresponding total SOFA score ( 5 ). However, this study was performed in a cohort of hospitalized patients with low mortality and thus probably less relevant for patients admitted to the emergency department (ED) with suspected sepsis ( 5 ).…”

mentioning

confidence: 98%

See 2 more Smart Citations

Mortality and Sequential Organ Failure Assessment Score in Patients With Suspected Sepsis: The Impact of Acute and Preexisting Organ Failures and Infection Likelihood

Christensen

Prebensen

Martinsen

et al. 2023

Critical Care Explorations

View full text Add to dashboard Cite

IMPORTANCE: The Sequential Organ Failure Assessment (SOFA) was chosen in the definition of sepsis due to superior validity in predicting mortality. However, few studies have assessed the contributions of acute versus chronic organ failures to SOFA for mortality prediction. OBJECTIVES: The main objective in this study was to assess the relative importance of chronic and acute organ failures in mortality prediction in patients with suspected sepsis at hospital admission. We also evaluated how the presence of infection influenced the ability of SOFA to predict 30-day mortality. DESIGN, SETTING, AND PARTICIPANTS: Single-center prospective cohort study including 1,313 adult patients with suspected sepsis in rapid response teams in the emergency department. MAIN OUTCOMES AND MEASURES: The main outcome was 30-day mortality. We measured the maximum total SOFA score during admission (SOFATotal), whereas preexisting chronic organ failure SOFA (SOFAChronic) score was assessed by chart review, allowing calculation of the corresponding acute SOFA (SOFAAcute) score. Likelihood of infection was determined post hoc as “No infection” or “Infection.” RESULTS: SOFAAcute and SOFAChronic were both associated with 30-day mortality, adjusted for age and sex (adjusted odds ratios [AORs], 1.3; 95% CI, 1.3–14 and 1.3; 1.2–1.7), respectively. Presence of infection was associated with lower 30-day mortality (AOR, 0.4; 95% CI, 0.2–0.6), even when corrected for SOFA. In “No infection” patients, SOFAAcute was not associated with mortality (AOR, 1.1; 95% CI, 1.0–1.2), and in this subgroup, neither SOFAAcute greater than or equal to 2 (relative risk [RR], 1.1; 95% CI, 0.6–1.8) nor SOFATotal greater than or equal to 2 (RR, 3.6; 95% CI, 0.9–14.1) was associated with higher mortality. CONCLUSIONS AND RELEVANCE: Chronic and acute organ failures were equally associated with 30-day mortality in suspected sepsis. A substantial part of the total SOFA score was due to chronic organ failure, calling for caution when using total SOFA in defining sepsis and as an outcome in intervention studies. SOFA’s mortality prediction ability was highly dependent on actual presence of infection.

show abstract

Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

See 1 more Smart Citation

Mortality and Sequential Organ Failure Assessment Score in Patients With Suspected Sepsis: The Impact of Acute and Preexisting Organ Failures and Infection Likelihood

Christensen

Prebensen

Martinsen

et al. 2023

Critical Care Explorations

View full text Add to dashboard Cite

show abstract

“…As SOFA was designed for critical care it was anticipated that there would be a significant number of missing values for the respiratory component which requires an arterial blood gas to calculate the PaO 2 /FiO 2 ratio. There are several available alternatives for ward patients [ 27 , 28 ] which use combinations of inspired oxygen and oxygen saturations. We used Valik et al’s [ 29 ] method which allocates a SOFA score of 1 for oxygen saturations of 91–94% and 2 for oxygen saturations of less than 91% as a replacement for the missing data because it performed better than either the original SOFA scoring [ 9 ] or Gadrey et al [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Performance of bedside tools for predicting infection-related mortality and administrative data for sepsis surveillance: An observational cohort study

Bateson

Marwick²,

Staines³

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Background Measuring sepsis incidence and associated mortality at scale using administrative data is hampered by variation in diagnostic coding. This study aimed first to compare how well bedside severity scores predict 30-day mortality in hospitalised patients with infection, then to assess the ability of combinations of administrative data items to identify patients with sepsis. Methods This retrospective case note review examined 958 adult hospital admissions between October 2015 and March 2016. Admissions with blood culture sampling were matched 1:1 to admissions without a blood culture. Case note review data were linked to discharge coding and mortality. For patients with infection the performance characteristics of Sequential Organ Failure Assessment (SOFA), National Early Warning System (NEWS), quick SOFA (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS) were calculated for predicting 30-day mortality. Next, the performance characteristics of administrative data (blood cultures and discharge codes) for identifying patients with sepsis, defined as SOFA ≥2 because of infection, were calculated. Results Infection was documented in 630 (65.8%) admissions and 347 (55.1%) patients with infection had sepsis. NEWS (Area Under the Receiver Operating Characteristic, AUROC 0.78 95%CI 0.72–0.83) and SOFA (AUROC 0.77, 95%CI 0.72–0.83), performed similarly well for prediction of 30-day mortality. Having an infection and/or sepsis International Classification of Diseases, Tenth Revision (ICD-10) code (AUROC 0.68, 95%CI 0.64–0.71) performed as well in identifying patients with sepsis as having at least one of: an infection code; sepsis code, or; blood culture (AUROC 0.68, 95%CI 0.65–0.71), Sepsis codes (AUROC 0.53, 95%CI 0.49–0.57) and positive blood cultures (AUROC 0.52, 95%CI 0.49–0.56) performed least well. Conclusions SOFA and NEWS best predicted 30-day mortality in patients with infection. Sepsis ICD-10 codes lack sensitivity. For health systems without suitable electronic health records, blood culture sampling has potential utility as a clinical component of a proxy marker for sepsis surveillance.

show abstract

“…However, as the proportion of missing data increases, these imputation methods become increasingly more unreliable 16 . Outside the intensive care unit (ICU), ABGs are missing in over 75% of cases 17,18 . It is not surprising, therefore, that the only models that used the measured P/F ratio were derived in the ICU.…”

Section: Introductionmentioning

confidence: 99%

Overt and occult hypoxemia in patients hospitalized with novel coronavirus disease 2019

Gadrey

Mohanty

Haughey

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Progressive hypoxemia is the predominant mode of deterioration in COVID-19. Among hypoxemia measures, the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (P/F ratio) has optimal construct validity but poor availability because it requires arterial blood sampling. Pulse oximetry reports oxygenation continuously, but occult hypoxemia can occur in Black patients because the technique is affected by skin color. Oxygen dissociation curves allow non-invasive estimation of P/F ratios (ePFR) but this approach remains unproven. Research Question: Can ePFRs measure overt and occult hypoxemia? Study Design and methods: We retrospectively studied COVID-19 hospital encounters (n=5319) at two academic centers (University of Virginia [UVA] and Emory University). We measured primary outcomes (death or ICU transfer within 24 hours), ePFR, conventional hypoxemia measures, baseline predictors (age, sex, race, comorbidity), and acute predictors (National Early Warning Score (NEWS) and Sepsis-3). We updated predictors every 15 minutes. We assessed predictive validity using adjusted odds ratios (AOR) and area under receiver operating characteristics curves (AUROC). We quantified disparities (Black vs non-Black) in empirical cumulative distributions using the Kolmogorov-Smirnov (K-S) two-sample test. Results: Overt hypoxemia (low ePFR) predicted bad outcomes (AOR for a 100-point ePFR drop: 2.7 [UVA]; 1.7 [Emory]; p<0.01) with better discrimination (AUROC: 0.76 [UVA]; 0.71 [Emory]) than NEWS (AUROC: 0.70 [UVA]; 0.70 [Emory]) or Sepsis-3 (AUROC: 0.68 [UVA]; 0.65 [Emory]). We found racial differences consistent with occult hypoxemia. Black patients had better apparent oxygenation (K-S distance: 0.17 [both sites]; p<0.01) but, for comparable ePFRs, worse outcomes than other patients (AOR: 2.2 [UVA]; 1.2 [Emory], p<0.01). Interpretation: The ePFR was a valid measure of overt hypoxemia. In COVID-19, it may outperform multi-organ dysfunction models like NEWS and Sepsis-3. By accounting for biased oximetry as well as clinicians' real-time responses to it (supplemental oxygen adjustment), ePFRs may enable statistical modelling of racial disparities in outcomes attributable to occult hypoxemia.

show abstract

The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 18 publications

Mortality and Sequential Organ Failure Assessment Score in Patients With Suspected Sepsis: The Impact of Acute and Preexisting Organ Failures and Infection Likelihood

Mortality and Sequential Organ Failure Assessment Score in Patients With Suspected Sepsis: The Impact of Acute and Preexisting Organ Failures and Infection Likelihood

Performance of bedside tools for predicting infection-related mortality and administrative data for sepsis surveillance: An observational cohort study

Overt and occult hypoxemia in patients hospitalized with novel coronavirus disease 2019

Contact Info

Product

Resources

About