Ground truth labels challenge the validity of sepsis consensus definitions in critical illness

Autor: Holger A. Lindner, Shigehiko Schamoni, Thomas Kirschning, Corinna Worm, Bianka Hahn, Franz-Simon Centner, Jochen J. Schoettler, Michael Hagmann, Jörg Krebs, Dennis Mangold, Stephanie Nitsch, Stefan Riezler, Manfred Thiel, Verena Schneider-Lindner
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Journal of Translational Medicine, Vol 20, Iss 1, Pp 1-29 (2022)
Druh dokumentu: article
ISSN: 1479-5876
DOI: 10.1186/s12967-022-03228-7
Popis: Abstract Background Sepsis is the leading cause of death in the intensive care unit (ICU). Expediting its diagnosis, largely determined by clinical assessment, improves survival. Predictive and explanatory modelling of sepsis in the critically ill commonly bases both outcome definition and predictions on clinical criteria for consensus definitions of sepsis, leading to circularity. As a remedy, we collected ground truth labels for sepsis. Methods In the Ground Truth for Sepsis Questionnaire (GTSQ), senior attending physicians in the ICU documented daily their opinion on each patient’s condition regarding sepsis as a five-category working diagnosis and nine related items. Working diagnosis groups were described and compared and their SOFA-scores analyzed with a generalized linear mixed model. Agreement and discriminatory performance measures for clinical criteria of sepsis and GTSQ labels as reference class were derived. Results We analyzed 7291 questionnaires and 761 complete encounters from the first survey year. Editing rates for all items were > 90%, and responses were consistent with current understanding of critical illness pathophysiology, including sepsis pathogenesis. Interrater agreement for presence and absence of sepsis was almost perfect but only slight for suspected infection. ICU mortality was 19.5% in encounters with SIRS as the “worst” working diagnosis compared to 5.9% with sepsis and 5.9% with severe sepsis without differences in admission and maximum SOFA. Compared to sepsis, proportions of GTSQs with SIRS plus acute organ dysfunction were equal and macrocirculatory abnormalities higher (p
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