Background: The Sequential Organ Failure Assessment (SOFA) score is used to predict prognosis in subjects affected by severe sepsis and septic shock (SS). Troponin I (TnI) has been associated to worse outcomes in this setting. Internal and emergency departments often manage elderly patients affected by SS, often coaffected by several pathologies. In this setting, however, no prognostic index has been evaluated and data on survival and prognosis are derived from cohorts of patients treated in intensive care units. Patients and Methods:in the years 2015-2017 we enrolled all the consecutive patients admitted for SS in two Internal Medicine departments with expertise in critical care medicine. For each patient, we evaluated, at the admission: (1) SOFA score (2) TnI level (3) sex, age and comorbidities. Main outcome was defined as in-hospital mortality. We chose the best cutoff value for TnI and in-hospital death with ROC curve analysis, adopting Youden index. Then we calculated SOFA-T score adding 1 point to SOFA score if the admission TnI was above the calculated cutoff. Last, we compared the ROC curves of SOFA and SOFA-T with DeHanley method. Results: 390 subjects (age:79,6±11,4;males:49,2%) with 144 (36,9%) deaths; median SOFA score was 6 (0-15); mean TnI was 1,46 ng/ml (IQR:0,35). TnI predicted significantly the outcome (AUC:0,61;95%CI:0,56-0,66;p=0,0003) with an optimal cutoff of 0,315 ng/ml: TnI above this cutoff was associated to an increased risk of death for SS (OR:2,28;95%CI:1,68-3,07;p<0,0001). In this clinical setting, SOFA score showed a good predictive performance (AUC:0,68;95%CI:0,64-0,73;p<0,0001), which was significantly improved in SOFA-T (AUC:0,70;95%CI:0,65-0,75;p<0,0001). The difference between SOFA and SOFA-T was significant (AUC difference:0,15;p=0,001). Results the determination of TnI at the admission and its integration in a validated scoring system as SOFA can improve the prediction of in-hospital death of elderly patients affected by SS.
Zaccone V, F.L. (2018). Prediction of in-hospital death for sepsis or septic shock in internal medicine. Results from a multi center study: the SOFA-T score.
Prediction of in-hospital death for sepsis or septic shock in internal medicine. Results from a multi center study: the SOFA-T score
Falsetti L
Writing – Original Draft Preparation
;
2018
Abstract
Background: The Sequential Organ Failure Assessment (SOFA) score is used to predict prognosis in subjects affected by severe sepsis and septic shock (SS). Troponin I (TnI) has been associated to worse outcomes in this setting. Internal and emergency departments often manage elderly patients affected by SS, often coaffected by several pathologies. In this setting, however, no prognostic index has been evaluated and data on survival and prognosis are derived from cohorts of patients treated in intensive care units. Patients and Methods:in the years 2015-2017 we enrolled all the consecutive patients admitted for SS in two Internal Medicine departments with expertise in critical care medicine. For each patient, we evaluated, at the admission: (1) SOFA score (2) TnI level (3) sex, age and comorbidities. Main outcome was defined as in-hospital mortality. We chose the best cutoff value for TnI and in-hospital death with ROC curve analysis, adopting Youden index. Then we calculated SOFA-T score adding 1 point to SOFA score if the admission TnI was above the calculated cutoff. Last, we compared the ROC curves of SOFA and SOFA-T with DeHanley method. Results: 390 subjects (age:79,6±11,4;males:49,2%) with 144 (36,9%) deaths; median SOFA score was 6 (0-15); mean TnI was 1,46 ng/ml (IQR:0,35). TnI predicted significantly the outcome (AUC:0,61;95%CI:0,56-0,66;p=0,0003) with an optimal cutoff of 0,315 ng/ml: TnI above this cutoff was associated to an increased risk of death for SS (OR:2,28;95%CI:1,68-3,07;p<0,0001). In this clinical setting, SOFA score showed a good predictive performance (AUC:0,68;95%CI:0,64-0,73;p<0,0001), which was significantly improved in SOFA-T (AUC:0,70;95%CI:0,65-0,75;p<0,0001). The difference between SOFA and SOFA-T was significant (AUC difference:0,15;p=0,001). Results the determination of TnI at the admission and its integration in a validated scoring system as SOFA can improve the prediction of in-hospital death of elderly patients affected by SS.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
