Morbidity and mortality risk prediction models in sepsis

Gamboa Antiñolo, Fernando Miguel

doi:10.1016/j.medcle.2022.06.014

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It is a life-threatening condition where survival is determined by those decisions made in the first hour of healthcare. The risk prediction models are tools used to estimate the risk of an outcome in the context of specified variables and uncertainties. Until now, the tools to predict mortality in patients with suspected sepsis have focused mainly on predicting short-term prognosis, but sepsis and septic shock are also associated with a deterioration in the quality of life and higher long-term mortality after being discharged from hospital. Mortality prediction models (MPMs) estimate the risk of death in a patient population, and they can help stratify the risk and prognosis of an ill patient and thus help shared decision-making. Numerous scoring systems have been developed that predict sepsis-related mortality and its severity (PIRO, MEDS, MISSED, SOFA, qSOFA) and their usefulness is still under debate<a class="elsevierStyleCrossRef" href="#bib0005">1</a>. All of them can only be used as tools to guide decision-making, in an individual context, according to patient preferences, and not only as a strict criterion for admission to intensive care or other units.Recently, modifications to some models have been put forward, such as the addition of the determination of troponin (TntI) to the SOFA-T model. Since cardiovascular abnormalities are common in sepsis, and the troponins are elevated in these patients even in the absence of coronary artery disease, the addition of TntI has been shown to improve the prognostic performance of the SOFA model in elderly patients with sepsis admitted to intermediate care units<a class="elsevierStyleCrossRef" href="#bib0010">2</a>. Likewise, the combination of qSOFA and frailty makes it possible to identify the elderly with the worst prognosis<a class="elsevierStyleCrossRef" href="#bib0015">3</a>.A recent article in this magazine<a class="elsevierStyleCrossRef" href="#bib0020">4</a> analyses the performance of the qSOFA scale versus the classic inflammatory response criteria (SIRS), and it leads the authors to question the validity of the qSOFA index for decision-making in the A&E. The authors refer in their article to new classification tools in the A&E, such as the National Early Warning Score (NEWS)<a class="elsevierStyleCrossRef" href="#bib0025">5</a> scale, although this has also shown weaknesses<a class="elsevierStyleCrossRef" href="#bib0005">1</a>.Currently we do not have a specific MPM for adults with sepsis that meets adequate quality criteria. Physicians in emergency situations are unlikely to use complex MPMs that require many checkpoints. Recent data suggest that risk stratification tools based on machine learning may enable clinical decision support tools to stratify patient risk and prognosis and facilitate A&E decision-making<a class="elsevierStyleCrossRef" href="#bib0005">1</a>." "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pronostic tools for elderly patientes with sepsis: in search of new predictive models" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.M. 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Morciano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11739-020-02610-x" "Revista" => array:6 [ "tituloSerie" => "Intern Emerg Med" "fecha" => "2021" "volumen" => "16" "paginaInicial" => "981" "paginaFinal" => "988" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33428111" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frailly and associated outcomes and resource utilization among older ICU patients with suspected infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Fernando" 1 => "D.I. McIsaac" 2 => "J.J. Perry" 3 => "B. Rochwerg" 4 => "S.M. Bagshaw" 5 => "K. Thavorn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0000000000003831" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2019" "volumen" => "47" "paginaInicial" => "e669" "paginaFinal" => "e676" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31135504" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sepsis Code in emergency department: performance of q-SOFA score compared to SIRS score" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Robert Boter" 1 => "A. Steinherr Zazo" 2 => "G. Rocamora Blanch" 3 => "O. Antolin Caminal" 4 => "A. Carreres Molas" 5 => "J.M. Mòdol Deltell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2022" "volumen" => "158" "paginaInicial" => "260" "paginaFinal" => "264" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National Early Warning Score (NEWS) as prognostic triage tool for septic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Almutary" 1 => "S. Altthunayyan" 2 => "K. Alenazi" 3 => "A. Alqahtani" 4 => "B. Alotaibi" 5 => "M. Ahmed" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Inf Drug Resist" "fecha" => "2020" "volumen" => "13" "paginaInicial" => "3843" "paginaFinal" => "3851" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015900000010/v2_202301310819/S2387020622005101/v2_202301310819/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015900000010/v2_202301310819/S2387020622005101/v2_202301310819/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622005101?idApp=UINPBA00004N"]

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Vol. 159. Issue 10.

Pages e65 (November 2022)

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