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Published on: November 6, 2020
Development and validation of a modified SOFA score for mortality prediction in candidemia patients
Xiaofei Liu1, Ranran Ding1, Guangming Yang1
1Department of Intensive Care Unit, Jining NO. 1 People's Hospital, Jiankang road 6, Jining, 272000, Shandong, China.
Abstract:
Candidemia is a life-threatening bloodstream infection associated with high mortality rates, particularly in critically ill patients. Accurate risk stratification is crucial for timely intervention and could improve patient outcomes. This study aimed to enhance the predictive performance of the sequential organ failure assessment (SOFA) score by developing a modified SOFA (mSOFA) score, which is specifically designed for candidemia patients. Using data from MIMIC-III, MIMIC-IV, and ICU-JN databases, we identified key prognostic variables through LASSO regression and integrated into the mSOFA_3 model. The model incorporated respiratory_SOFA, coagulation_SOFA, and circulatory_SOFA along with clinical biomarkers, including lactate, albumin, and blood urea nitrogen. The mSOFA_3 model demonstrated superior predictive performance across multiple machine learning algorithms, with the logistic regression-based model achieving the highest AUC of 0.826 in the internal validation cohort and 0.813 in the test cohort. Kaplan-Meier survival analysis further validated the model's utility in stratifying patients into high-risk and low-risk groups with distinct survival outcomes. These findings highlight the mSOFA_3 as a robust and clinically relevant tool for early risk stratification, offering potential for improved decision-making and therapeutic management in critically ill patients with candidemia.
Insights
A new modified Sequential Organ Failure Assessment (mSOFA) score improves risk prediction for candidemia, a dangerous bloodstream infection. This tool helps identify high-risk patients for better management and outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Biostatistics
Background:
- Candidemia presents a significant threat to critically ill patients, necessitating accurate risk assessment for timely interventions.
- Existing scoring systems may not fully capture the nuances of candidemia prognosis.
- Early and precise risk stratification is vital for improving patient survival rates.
Purpose of the Study:
- To develop and validate a modified Sequential Organ Failure Assessment (mSOFA) score tailored for candidemia patients.
- To enhance the predictive accuracy of risk stratification in candidemia compared to the standard SOFA score.
- To integrate clinical biomarkers with organ-specific SOFA components for a more robust prognostic model.
Main Methods:
- Utilized data from MIMIC-III, MIMIC-IV, and ICU-JN databases for model development and validation.
- Employed LASSO regression to identify key prognostic variables for candidemia.
- Developed the mSOFA_3 model incorporating respiratory, coagulation, and circulatory SOFA components, alongside lactate, albumin, and blood urea nitrogen levels.
Main Results:
- The mSOFA_3 model demonstrated superior predictive performance, achieving an AUC of 0.826 in internal validation and 0.813 in the test cohort using logistic regression.
- Kaplan-Meier survival analysis confirmed the model's ability to differentiate between high-risk and low-risk patient groups.
- The enhanced model integrates readily available clinical data for practical application in critical care settings.
Conclusions:
- The mSOFA_3 score serves as a validated, robust tool for early risk stratification in critically ill candidemia patients.
- This modified score offers potential for improved clinical decision-making and therapeutic strategies.
- The findings support the clinical utility of mSOFA_3 in optimizing patient management and outcomes for candidemia.
