Interpretable Machine Learning Model for Predicting Sepsis and Septic Shock Among Patients with Documented Fever at...

This study aimed to develop an interpretable machine learning-based scoring system for predicting sepsis and septic shock among febrile patients at emergency department (ED) triage using longitudinal data. This retrospective, single-center study included adult patients, presented to ED of tertiary academic hospital with fever from January 2016 to December 2021. Using the AutoScore framework, we developed a novel scoring system for predicting sepsis and septic shock at the triage stage, incorporating nine variables and a maximum score of 29. The predictive performance of our score was assessed by calculating the area under the receiver operating characteristic curve (AUROC), and its performance was compared with that of two existing scoring systems: the quick Sequential Organ Failure Assessment (qSOFA) and the Modified Early Warning Score (MEWS). Our model incorporated nine variables including initial vital signs, age, baseline platelet count, total bilirubin, and creatinine levels. Among these, initial systolic blood pressure was identified as the most important predictor. AUROC of our model was 0.844 (95% confidence interval [CI], 0.812-0.875) in predicting septic shock and 0.703 (95% CI, 0.687-0.720) for sepsis. Compared to qSOFA ≥ 2 (AUROC: 0.605) and MEWS ≥ 5 (AUROC: 0.678), our scoring system demonstrated superior predictive performance for septic shock. For comparable specificity levels (ranging from 0.50 to 0.95), our scoring system achieved higher sensitivity than MEWS. Our scoring system is an interpretable and practical scoring tool for predicting sepsis and septic shock among patients with documented fever at ED triage using patient's longitudinal data.