A Novel Risk Tool To Predict The Severity And Prognosis Of Sepsis

Objective:To investigate the value of CALL score,REDS score,SMRS score,POSMI score and ANDC score in evaluating the disease severity and prognosis of patients with sepsis in emergency department.Methods:The clinical data of 318 patients with sepsis admitted to the Emergency department of the Second Hospital of Shanxi Medical University from January 2018 to July 2022 were retrospectively collected according to the inclusion and exclusion criteria.According to the clinical outcome during hospitalization,the patients were divided into survival group and death group.The treatment after admission with or without mechanical ventilation,the use of vasoactive drugs,and the length of hospital stay and distribution-whether the length of ICU stay accounted for more than 50% of the total length of hospital stay,and the total length of hospital stay were used as the severity criteria.The worst value of each index within 24 hours after admission was used to calculate the CALL score,REDS score,SMRS score,POSMI score,ANDC score,SOFA score,and APACHE Ⅱ score.Spearman correlation analysis and binary Logistic regression were used to evaluate the correlation between different score data and death and disease severity.The Receiver Operating Characteristic(ROC)curve was used to evaluate the predictive efficacy of different scoring systems for poor prognosis in patients with sepsis,and the ROC curve was used to transform continuous variables into binary variables.The K-M survival curve corresponding to each cut-off value and the relative hazard ratio for death under COX survival analysis were calculated.Results:(1)A total of 318 patients were enrolled in this study,with a median age of 63(51,71),42.9% of them were female,and the total length of hospital stay was 8(2,14).There were 189 patients(59.4%)in survival group and 129 patients(40.6%)in death group.Site of infection: 219 cases(68.7%)had pulmonary infection.There were 58 cases(18.2%)of urinary tract infection,55 cases(17.2%)of bloodstream related infection,21cases(6.6%)of abdominal infection,16 cases(5.0%)of skin infection,13 cases(4.1%)of intracranial infection,23 cases(8.2%)of gastrointestinal infection,and 60 cases(18.8%)of other infections.Underlying diseases: Among the patients with underlying diseases,there were 213 cases(66.8%)of hypertension,diabetes(61.1%),154 cases(48.3%)of cardiovascular disease,116 cases(36.4%)of liver cirrhosis,150 cases(47.0%)of immunosuppression,and 122 cases(38.6%)of renal failure.(2)Among the 10 prognostic evaluation indicators related to the severity of the disease,four indicators that were extremely related to the occurrence of adverse outcomes were screened out,including the proportion of the length of ICU stay in the total length of hospital stay(greater than or equal to 50%),with or without mechanical ventilation,the use of vasoactive drugs,and the total length of hospital stay.Among them,POSMI score,SOFA score and SMRS score were more correlated with the use of mechanical ventilation.POSMI score,SOFA score and REDS score were more correlated with the length of ICU stay.POSMI score,REDS score,POSMI score and SOFA score were significantly correlated with the use of vasoactive drugs.(3)In Spearman correlation analysis and single factor binary Logistic regression analysis,the occurrence of adverse outcomes in all cases was correlated with APACHE Ⅱ score,SMRS score,POSMI score,SOFA score,and REDS score(P<0.05).Multivariate Logistic regression results showed that: POSMI score [OR 1.166(1.064<1.279),B=0.154,p=0.001<0.05] was correlated with poor outcome,and its predictive ability was better than APACHE Ⅱ score.(4)When POSMI score,SMRS score,APACHE Ⅱ score,REDS score and SOFA score were used to evaluate the risk of death in patients with sepsis,the Area Under the ROC Curve(AUC)was calculated.AUC)were 0.706,0.684,0.682,0.664,0.384,respectively(all P<0.05),suggesting that SOFA score had a low value in predicting the poor prognosis of children with sepsis,POSMI score had the highest value in predicting the poor prognosis of children with sepsis,and SMRS score and REDS score had better predictive sensitivity.(5)According to the cut-off value of ROC curve,APACHE Ⅱ score,SMRS score,POSMI score and REDS score were divided into two groups,and K-M survival curve was drawn.The increase of four scores was an independent risk factor for death.COX multivariate risk regression further showed that when POSMI score was greater than 9.75,HR(relative hazard ratio)=1.836,which was significantly higher than APACHE Ⅱ score.Conclusion:(1)Higher POSMI score indicates more serious disease;(2)POSMI score was an independent risk factor for death in sepsis patients;(3)POSMI score had the best predictive ability of death;(4)Compared with other scores,patients with higher POSMI score(≥3.5)had the greatest risk of shortened survival.In conclusion,POSMI score shows a better integrated prediction ability with mortality risk,survival time and disease severity,and is an effective new prediction tool.