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Development and internal validation of simplified predictive scoring (ICU-SEPSA score) for mortality in patients with
Taranee Sirichayanugul1, Chansinee Srisawat2, Chawin Thummakomut3
1Division of Drug Information, Department of Pharmacy, Phrae Hospital, Phrae, Thailand.
Abstract:
Background: Mortality from multidrug-resistant (MDR) pathogens is an urgent healthcare crisis worldwide. At present we do not have any simplified screening tools to predict the risk of mortality associated with MDR infections. The aim of this study was to develop a screening tool to predict mortality in patients with multidrug-resistant organisms. Methods: A retrospective cohort study to evaluate mortality risks in patients with MDR infections was conducted at Phrae Hospital. Univariable and multivariable analyses were used to classify possible risk factors. The model performance was internally validated utilizing the mean of three measures of discrimination corrected by the optimism using a 1000-bootstrap procedure. The coefficients were transformed into item scores by dividing each coefficient with the lowest coefficient and then rounding to the most adjacent number. The area under the receiver operating characteristic curve (AuROC) was used to determine the performance of the model. Results: Between 1 October 2018 and 30 September 2020, a total of 504 patients with MDR infections were enrolled. The ICU-SEPSA score composed of eight clinical risk factors: 1) immunocompromised host, 2) chronic obstructive pulmonary disease, 3) urinary tract infection, 4) sepsis, 5) placement of endotracheal tube, 6) pneumonia, 7) septic shock, and 8) use of antibiotics within the past 3 months. The model showed good calibration (Hosmer-Lemeshow χ2 = 19.27; p-value = 0.50) and good discrimination after optimism correction (AuROC 84.6%, 95% confidence interval [Cl]: 81.0%-88.0%). The positive likelihood ratio of low risk (score ≤ 5) and high risk (score ≥ 8) were 2.07 (95% CI: 1.74-2.46) and 12.35 (95% CI: 4.90-31.13), respectively. Conclusion: A simplified predictive scoring tool wad developed to predict mortality in patients with MDR infections. Due to a single-study design of this study, external validation of the results before applying in other clinical practice settings is warranted.
Insights
A new scoring tool, the ICU-SEPSA score, helps predict mortality risk in patients with multidrug-resistant (MDR) infections. This simplified screening method aids in identifying high-risk individuals for better patient outcomes.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Public Health
Background:
- Mortality from multidrug-resistant (MDR) pathogens presents a significant global healthcare challenge.
- Current screening tools for predicting MDR infection mortality risk are limited.
- There is a critical need for simplified methods to assess mortality risk in patients with MDR organisms.
Purpose of the Study:
- To develop and validate a simplified screening tool for predicting mortality in patients with multidrug-resistant organism infections.
- To identify key clinical risk factors associated with increased mortality in MDR infections.
- To create a practical scoring system for clinical use.
Main Methods:
- A retrospective cohort study was conducted at Phrae Hospital involving 504 patients with MDR infections.
- Univariable and multivariable analyses identified significant risk factors for mortality.
- Internal validation used a 1000-bootstrap procedure and receiver operating characteristic (AuROC) analysis to assess model performance.
Main Results:
- The ICU-SEPSA score incorporates eight clinical risk factors: immunocompromised host, COPD, UTI, sepsis, endotracheal tube placement, pneumonia, septic shock, and recent antibiotic use.
- The model demonstrated good calibration (p=0.50) and discrimination (AuROC 84.6%).
- Positive likelihood ratios indicated significant predictive value for low (2.07) and high (12.35) risk scores.
Conclusions:
- A simplified predictive scoring tool, the ICU-SEPSA score, was successfully developed to predict mortality in patients with MDR infections.
- The tool shows good performance in discriminating between low and high mortality risk.
- External validation is recommended before widespread clinical application due to the single-study design.
