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An outcome predictive score for sepsis and death following injury
M J Hershman1, W G Cheadle, D Kuftinec
1University of Louisville, Kentucky.
Insights
A new outcome predictive score (OPS) effectively differentiates patient outcomes after severe injury, distinguishing between sepsis survivors and non-survivors. This score aids in identifying high-risk patients for prioritized care.
Area of Science:
- Trauma care
- Immunology
- Predictive scoring
Background:
- Severe injury significantly contributes to morbidity and mortality, especially in younger populations.
- Current scoring systems lack focus on immune response capabilities in trauma patients.
- There is a need for a predictive tool that incorporates immune markers for better patient outcome assessment.
Purpose of the Study:
- To develop and validate an outcome predictive score (OPS) for severely injured patients.
- To assess the score's ability to predict sepsis development and patient survival.
- To identify patients at high risk for adverse outcomes, enabling timely interventions.
Main Methods:
- Developed an outcome predictive score (OPS) integrating Injury Severity Score (ISS) as %LD50, bacterial contamination degree, and monocyte DR antigen expression.
- Evaluated the OPS in 51 severely injured patients categorized into three groups: no infection (N=15), survived sepsis (N=24), and died (N=12).
- Compared the mean OPS across the three patient groups to determine predictive accuracy.
Main Results:
- No significant difference in Injury Severity Score (ISS) was observed among the groups.
- The mean OPS was significantly lower in the good outcome group compared to both the septic (P < 0.0002) and non-surviving (P < 0.00001) groups.
- The septic survivor group had a significantly lower mean OPS than the non-surviving group (P < 0.002), indicating predictive value.
Conclusions:
- The outcome predictive score (OPS) effectively distinguishes between patients with good outcomes, sepsis survivors, and those who die from sepsis.
- OPS provides a valuable tool for assessing immune capability and predicting patient trajectories post-severe injury.
- Early identification of high-risk patients using OPS can guide treatment priorities and enhance patient care strategies.
Abstract:
Injury is an important cause of both morbidity and mortality, particularly in the young. Scoring systems have been developed to establish guidelines of transfer and compare patient outcome, but no scoring system as yet has been constructed that focuses upon immune capability of these patients. We report an outcome predictive score (OPS) which appears to distinguish good outcome from sepsis in patients who survive, and between patients with sepsis who survive from patients with sepsis who die. The score is based on (1) Injury severity score (ISS) expressed as percentage of the 50 per cent lethal dose of injury for age (%LD50), (2) Degree of bacterial contamination at initial injury, (3) The patient's monocyte DR antigen expression. Fifty-one severely injured patients were divided into three groups: (1) A group without infection (N = 15), (2) A major sepsis group which survived (N = 24), (3) A group who died (N = 12). There was no difference between the ISS of these groups. The mean OPS of the good outcome group was significantly less than the mean OPS of both the septic (P less than 0.0002) and dead (P less than 0.00001) groups. The mean OPS of the septic group was also significantly less than the mean of the group that died (P less than 0.002). Identification of high risk patients may be important to determine priority of patient care and to institute additional therapeutic measures.