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CHARACTERISTICS AND PREDICTORS OF PATIENTS WITH SEPSIS WHO ARE CANDIDATES FOR MINIMALLY INVASIVE APPROACH OUTSIDE OF
Abdul Wahab1, Ryan J Smith2, Amos Lal3
1Department of Hospital Medicine, Mayo Clinic Health System, Mankato, Minnesota.
Abstract:
Objective: To identify and describe characteristics of patients with sepsis who could be treated with minimally invasive sepsis (MIS) approach without intensive care unit (ICU) admission and to develop a prediction model to select candidates for MIS approach. Methods: A secondary analysis of the electronic database of patients with sepsis at Mayo Clinic, Rochester, MN. Candidates for the MIS approach were adults with septic shock and less than 48 hours of ICU stay, who did not require advanced respiratory support and were alive at hospital discharge. Comparison group consisted of septic shock patients with an ICU stay of more than 48 hours without advanced respiratory support at the time of ICU admission. Results: Of 1795 medical ICU admissions, 106 patients (6%) met MIS approach criteria. Predictive variables (age >65 years, oxygen flow >4 L/min, temperature <37°C, creatinine >1.6 mg/dL, lactate >3 mmol/L, white blood cells >15 × 10 9 /L, heart rate >100 beats/min, and respiration rate >25 breaths/min) selected through logistic regression were translated into an 8-point score. Model discrimination yielded the area under the receiver operating characteristic curve of 79% and was well fitted (Hosmer-Lemeshow P = 0.94) and calibrated. The MIS score cutoff of 3 resulted in a model odds ratio of 0.15 (95% confidence interval, 0.08-0.28) and a negative predictive value of 91% (95% confidence interval, 88.69-92.92). Conclusions: This study identifies a subset of low-risk septic shock patients who can potentially be managed outside the ICU. Once validated in an independent, prospective sample our prediction model can be used to identify candidates for MIS approach.
Insights
This study identifies low-risk septic shock patients suitable for a minimally invasive sepsis (MIS) approach outside the intensive care unit (ICU). A validated prediction model can help select these candidates for MIS treatment.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Health Services Research
Background:
- Sepsis management often necessitates intensive care unit (ICU) admission.
- Identifying patients suitable for less intensive care is crucial for resource optimization.
- Minimally invasive sepsis (MIS) approaches may be viable for select patient populations.
Purpose of the Study:
- To characterize patients with sepsis eligible for a minimally invasive sepsis (MIS) approach without ICU admission.
- To develop and validate a predictive model for selecting candidates for MIS treatment.
Main Methods:
- Secondary analysis of electronic health records for patients with sepsis.
- Defined MIS candidates as adults with septic shock, <48 hours ICU stay, no advanced respiratory support, and alive at discharge.
- Developed an 8-point prediction score using logistic regression on key clinical variables.
Main Results:
- 106 out of 1795 (6%) ICU admissions met MIS criteria.
- Key predictors included age, oxygen requirement, temperature, creatinine, lactate, white blood cell count, heart rate, and respiratory rate.
- The MIS score demonstrated good discrimination (AUC 79%) and calibration, with a cutoff of 3 yielding a negative predictive value of 91%.
Conclusions:
- A subset of low-risk septic shock patients can potentially be managed outside the ICU.
- The developed prediction model can aid in identifying suitable candidates for the MIS approach.
- Further validation in prospective studies is recommended before clinical implementation.
