Scale to predict risk for refractory septic shock based on a hybrid approach using machine learning and regression
Sejin Heo1, Daun Jeong2, Minyoung Choi1
1Department of Emergency Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
Summary
A new Refractory Septic Shock Scale (RSSS) was developed using clinical data to predict severe septic shock. This tool shows good accuracy in identifying patients who will develop refractory septic shock.
Area of Science:
- Critical Care Medicine
- Clinical Prediction Models
- Sepsis Research
Background:
- Refractory septic shock (SS) presents a significant challenge in intensive care settings.
- Early prediction of refractory SS is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To develop and validate a novel clinical scale, the Refractory SS Scale (RSSS), for predicting refractory SS.
- To identify key clinical variables for early SS prognostication.
Main Methods:
- A multicenter retrospective study utilizing data from the MIMIC-IV database for scale development.
- External validation was performed on two independent cohorts: an emergency department (ED) cohort and a hospital intensive care unit (ICU) cohort.
- A machine-learning approach (AutoScore) was employed for scale development and performance assessment using Area Under the Receiver Operating Characteristic Curve (AUROC).
Main Results:
- The RSSS incorporates six predictors: serum lactate, systolic blood pressure, heart rate, temperature, arterial pH, and leukocyte count.
- Internal validation showed an AUROC of 0.873.
- External validation yielded AUROCs of 0.705 (ED cohort on arrival), 0.781 (ED cohort at hypoperfusion/hypotension diagnosis), and 0.822 (ICU cohort), with acceptable calibration across all cohorts.
Conclusions:
- The developed Refractory SS Scale (RSSS) demonstrates adequate diagnostic accuracy for predicting refractory septic shock.
- The RSSS is a promising tool for early identification of patients at high risk for refractory SS in both emergency and intensive care settings.
