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

Autor:	Gadrey SM; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA., Clay R; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Zimmet AN; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA., Lawson AS; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Oliver SF; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Richardson ED; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Forrester VJ; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Andris RT; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA., Rhodes GT; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Voss JD; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Moore CC; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA., Moorman JR; Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2020 Sep 25; Vol. 2 (10), pp. e0199. Date of Electronic Publication: 2020 Sep 25 (Print Publication: 2020).
DOI:	10.1097/CCE.0000000000000199
Abstrakt:	The Sepsis-3 taskforce defined sepsis as suspicion of infection and an acute rise in the Sequential Organ Failure Assessment score by 2 points over the preinfection baseline. Sepsis-3 studies, though, have not distinguished between acute and chronic organ failure, and may not accurately reflect the epidemiology, natural history, or impact of sepsis. Our objective was to determine the extent to which the predictive validity of Sepsis-3 is attributable to chronic rather than acute organ failure. Design: Retrospective cohort study. Setting: General medicine inpatient service at a tertiary teaching hospital. Patients: A total of 3,755 adult medical acute-care encounters (1,864 confirmed acute infections) over 1 year. Interventions: None. Measurements and Main Results: We measured the total Sequential Organ Failure Assessment score at the onset of infection and separated its components (baseline and acute rise) using case-by-case chart reviews. We compared the predictive validities of acuity-focused (acute rise in Sequential Organ Failure Assessment ≥ 2) and conventional (total Sequential Organ Failure Assessment ≥ 2) implementations of Sepsis-3 criteria. Measures of predictive validity were change in the rate of outcomes and change in the area under receiver operating characteristic curves after adding sepsis criteria to multivariate logistic regression models of baseline risk (age, sex, race, and Charlson comorbidity index). Outcomes were inhospital mortality (primary) and ICU transfer or inhospital mortality (secondary). Acuity-focused implementations of Sepsis-3 were associated with neither a change in mortality (2.2% vs 1.2%; p = 0.18) nor a rise in area under receiver operating characteristic curves compared with baseline models (0.67 vs 0.66; p = 0.75). In contrast, conventional implementations were associated with a six-fold change in mortality (2.4% vs 0.4%; p = 0.01) and a rise in area under receiver operating characteristic curves compared with baseline models (0.70 vs 0.66; p = 0.04). Results were similar for the secondary outcome. Conclusions: The evaluation of the validity of organ dysfunction-based clinical sepsis criteria is prone to bias, because acute organ dysfunction consequent to infection is difficult to separate from preexisting organ failure in large retrospective cohorts. Competing Interests: Dr. Moorman has ownership interests in AMP3D (Charlottesville, VA), a company that provides advanced predictive analytic solutions. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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