Development and Validation of a Sepsis Mortality Risk Score for Sepsis-3 Patients in Intensive Care Unit.
Development and Validation of a Sepsis Mortality Risk Score for Sepsis-3 Patients in Intensive Care Unit.
复制标题
重症监护病房脓毒症 3 级患者脓毒症死亡风险评分的制定和验证。
DOI：
10.3389/fmed.2020.609769
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发表时间：
2020
影响因子：
3.9
通讯作者：
Zhang Z
中科院分区：
文献类型：
--
作者：
Zhang K;Zhang S;Cui W;Hong Y;Zhang G;Zhang Z
背景：许多严重程度评分被广泛用于重症监护病房（ICU）危重症患者的临床预后预测。然而，对于符合脓毒症 - 3标准的患者，尚未开发出此类评分。本研究旨在开发并验证一种用于脓毒症 - 3患者死亡率预测的风险分层评分。
方法：在这项回顾性队列研究中，我们使用重症监护医学信息库III（MIMIC III）数据库进行模型开发，并使用eICU数据库进行外部验证。我们在患者进入ICU的第1天根据脓毒症 - 3标准确定脓毒症患者。采用最小绝对收缩和选择算子（LASSO）技术来选择预测变量。我们还开发了一个脓毒症死亡率预测模型以及相关的风险分层评分。然后，我们将该模型的区分度和校准度与其他传统的严重程度评分进行了比较。
结果：在模型开发中，我们共纳入了5443名符合脓毒症 - 3标准的患者。30天死亡率为16.7%。在验证集中有5658名脓毒症患者，其中1135人死亡（死亡率20.1%）。该评分在开发集和验证集中具有良好的区分度（曲线下面积：0.789和0.765）。在验证集中，校准斜率为0.862，布里尔值为0.140。在开发数据集中，该评分根据低（3.2%）、中（12.4%）、高（30.7%）和极高（68.1%）的死亡风险对患者进行了分层。验证数据集中相应的死亡率分别为2.8%、10.5%、21.1%和51.2%。决策曲线分析表明，该评分始终具有正的净效益。
结论：我们观察到被称为脓毒症死亡风险评分（SMRS）的评分具有中等的区分度和校准度，能够根据死亡风险对患者进行分层。然而，我们仍需要进一步的改进和外部验证。
Background: Many severity scores are widely used for clinical outcome prediction for critically ill patients in the intensive care unit (ICU). However, for patients identified by sepsis-3 criteria, none of these have been developed. This study aimed to develop and validate a risk stratification score for mortality prediction in sepsis-3 patients. Methods: In this retrospective cohort study, we employed the Medical Information Mart for Intensive Care III (MIMIC III) database for model development and the eICU database for external validation. We identified septic patients by sepsis-3 criteria on day 1 of ICU entry. The Least Absolute Shrinkage and Selection Operator (LASSO) technique was performed to select predictive variables. We also developed a sepsis mortality prediction model and associated risk stratification score. We then compared model discrimination and calibration with other traditional severity scores. Results: For model development, we enrolled a total of 5,443 patients fulfilling the sepsis-3 criteria. The 30-day mortality was 16.7%. With 5,658 septic patients in the validation set, there were 1,135 deaths (mortality 20.1%). The score had good discrimination in development and validation sets (area under curve: 0.789 and 0.765). In the validation set, the calibration slope was 0.862, and the Brier value was 0.140. In the development dataset, the score divided patients according to mortality risk of low (3.2%), moderate (12.4%), high (30.7%), and very high (68.1%). The corresponding mortality in the validation dataset was 2.8, 10.5, 21.1, and 51.2%. As shown by the decision curve analysis, the score always had a positive net benefit. Conclusion: We observed moderate discrimination and calibration for the score termed Sepsis Mortality Risk Score (SMRS), allowing stratification of patients according to mortality risk. However, we still require further modification and external validation.
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DOI：
10.1186/cc13106
发表时间：
2013-11-13
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kushimoto S;Gando S;Saitoh D;Mayumi T;Ogura H;Fujishima S;Araki T;Ikeda H;Kotani J;Miki Y;Shiraishi S;Suzuki K;Suzuki Y;Takeyama N;Takuma K;Tsuruta R;Yamaguchi Y;Yamashita N;Aikawa N;JAAM Sepsis Registry Study Group
通讯作者：
JAAM Sepsis Registry Study Group
影响因子：
8.8
作者：
Ford DW;Goodwin AJ;Simpson AN;Johnson E;Nadig N;Simpson KN
通讯作者：
Simpson KN
影响因子：
3.7
作者：
Nassar, Antonio Paulo, Jr.;Mocelin, Amilcar Oshiro;Dias, Carlos Augusto
通讯作者：
Dias, Carlos Augusto
DOI：
10.1186/s13049-019-0609-3
发表时间：
2019-04-30
影响因子：
3.3
作者：
Liu, Zhiqiang;Meng, Zibo;Wu, Heshui
通讯作者：
Wu, Heshui
影响因子：
105.7
作者：
Collins, Gary S.;Reitsma, Johannes B.;Moons, Karel G. M.
通讯作者：
Moons, Karel G. M.