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Establishment of a prognostic model for patients with sepsis based on SOFA: a retrospective cohort study
Hui Liu1, Luming Zhang1,2, Fengshuo Xu2,3
1Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
Objective:
To construct a nomogram based on the Sequential Organ Failure Assessment (SOFA) that is more accurate in predicting 30-, 60-, and 90-day mortality risk in patients with sepsis.
Methods:
Data from patients with sepsis were retrospectively collected from the Medical Information Mart for Intensive Care (MIMIC) database. Included patients were randomly divided into training and validation cohorts. Variables were selected using a backward stepwise selection method with Cox regression, then used to construct a prognostic nomogram. The nomogram was compared with the SOFA model using the concordance index (C-index), area under the time-dependent receiver operating characteristics curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting, and decision-curve analysis (DCA).
Results:
A total of 5240 patients were included in the study. Patient's age, SOFA score, metastatic cancer, SpO2, lactate, body temperature, albumin, and red blood cell distribution width were included in the nomogram. The C-index, AUC, NRI, IDI, and DCA of the nomogram showed that it performs better than the SOFA alone.
Conclusion:
A nomogram was established that performed better than the SOFA in predicting 30-, 60-, and 90-day mortality risk in patients with sepsis.
Insights
A new nomogram improves sepsis mortality prediction. This tool, based on the Sequential Organ Failure Assessment (SOFA) score, offers more accurate 30-, 60-, and 90-day risk assessments for sepsis patients.
Area of Science:
- Critical Care Medicine
- Biostatistics
- Prognostic Modeling
Background:
- Sepsis poses a significant mortality risk.
- Accurate prediction of sepsis mortality is crucial for timely intervention.
- Existing models like the Sequential Organ Failure Assessment (SOFA) may require enhancement.
Purpose of the Study:
- To develop and validate a novel prognostic nomogram for predicting sepsis-related mortality.
- To improve upon the predictive accuracy of the SOFA score for 30-, 60-, and 90-day mortality.
- To identify key clinical variables that contribute to sepsis mortality risk.
Main Methods:
- Retrospective analysis of sepsis patient data from the MIMIC database.
- Development of a prognostic nomogram using backward stepwise Cox regression.
- Validation of the nomogram against the SOFA score using C-index, AUC, NRI, IDI, and DCA.
Main Results:
- A nomogram incorporating age, SOFA score, metastatic cancer, SpO2, lactate, body temperature, albumin, and RDW was constructed.
- The developed nomogram demonstrated superior performance compared to the SOFA score alone.
- Statistical metrics including C-index, AUC, NRI, IDI, and DCA confirmed the nomogram's enhanced predictive capability.
Conclusions:
- A novel nomogram significantly improves the prediction of 30-, 60-, and 90-day mortality in sepsis patients.
- The nomogram offers a more accurate and refined prognostic tool than the SOFA score.
- This enhanced model can aid clinicians in risk stratification and management of sepsis.
