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

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...

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Autores principales: Gadrey, Shrirang M., Clay, Russ, Zimmet, Alex N., Lawson, Alexander S., Oliver, Samuel F., Richardson, Emily D., Forrester, Vernon J., Andris, Robert T., Rhodes, Garret T., Voss, John D., Moore, Christopher C., Moorman, J. Randall
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523827/
https://www.ncbi.nlm.nih.gov/pubmed/33063019
http://dx.doi.org/10.1097/CCE.0000000000000199
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author Gadrey, Shrirang M.
Clay, Russ
Zimmet, Alex N.
Lawson, Alexander S.
Oliver, Samuel F.
Richardson, Emily D.
Forrester, Vernon J.
Andris, Robert T.
Rhodes, Garret T.
Voss, John D.
Moore, Christopher C.
Moorman, J. Randall
author_facet Gadrey, Shrirang M.
Clay, Russ
Zimmet, Alex N.
Lawson, Alexander S.
Oliver, Samuel F.
Richardson, Emily D.
Forrester, Vernon J.
Andris, Robert T.
Rhodes, Garret T.
Voss, John D.
Moore, Christopher C.
Moorman, J. Randall
author_sort Gadrey, Shrirang M.
collection PubMed
description 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.
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spelling pubmed-75238272020-10-14 The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria Gadrey, Shrirang M. Clay, Russ Zimmet, Alex N. Lawson, Alexander S. Oliver, Samuel F. Richardson, Emily D. Forrester, Vernon J. Andris, Robert T. Rhodes, Garret T. Voss, John D. Moore, Christopher C. Moorman, J. Randall Crit Care Explor Observational Study 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. Lippincott Williams & Wilkins 2020-09-25 /pmc/articles/PMC7523827/ /pubmed/33063019 http://dx.doi.org/10.1097/CCE.0000000000000199 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Observational Study
Gadrey, Shrirang M.
Clay, Russ
Zimmet, Alex N.
Lawson, Alexander S.
Oliver, Samuel F.
Richardson, Emily D.
Forrester, Vernon J.
Andris, Robert T.
Rhodes, Garret T.
Voss, John D.
Moore, Christopher C.
Moorman, J. Randall
The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria
title The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria
title_full The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria
title_fullStr The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria
title_full_unstemmed The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria
title_short The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria
title_sort relationship between acuity of organ failure and predictive validity of sepsis-3 criteria
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523827/
https://www.ncbi.nlm.nih.gov/pubmed/33063019
http://dx.doi.org/10.1097/CCE.0000000000000199
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