Development and internal validation of a simple prognostic score for early sepsis risk stratification in the emergency department

OBJECTIVES: No validated, simple, powerful and continuously monitorable risk prediction tools are available for patients with sepsis during the early phases in the emergency department (ED). We sought to derive a novel Simple Sepsis Early Prognostic Score (SSEPS) composed of physiological indicators that do not depend on laboratory tests and that can be used by emergency clinicians in predicting outcomes in patients with sepsis. DESIGN: Retrospective cohort analysis of a collected data source. PARTICIPANTS: Patients with sepsis admitted to the ED of the West China Hospital of Sichuan University between July 2015 and June 2016 were included. We excluded patients who were pregnant, those with cardiac or respiratory arrest, and those using vasoactive drugs before admission to the ED. PRIMARY OUTCOME MEASURES: 28-day all-cause mortality. RESULTS: The SSEPS consisted of age, heart rate, respiratory rate and altered consciousness. Patients in the development cohort with higher SSEPS had a significantly higher mortality (first tertile vs second tertile vs third tertile: 12.5% vs 28.6% vs 53.5%, p<0.001). The area under the receiver operating characteristic curve for SSEPS was 0.762 (95% CI 0.686 to 0.838), which was similar to Sequential Organ Failure Assessment (SOFA) (area under the curve: 0.745, 95% CI 0.692 to 0.798) and Acute Physiology and Chronic Health Evaluation (APACHE II) (area under the curve: 0.750, 95% CI 0.681 to 0.819). Moreover, the decision curve analysis showed that the net benefit of SSEPS was higher than SOFA and APACHE II at any probability threshold. CONCLUSION: The SSEPS is simple and useful for clinicians in stratifying high-risk patients with sepsis at the early phase of ED admission.