The online version of this article (doi:10.1186/1471-2253-14-1) contains supplementary material, which is available to authorized users.
All authors have declared that they have no competing interest.
Early aggressive therapy can reduce the mortality associated with severe sepsis but this relies on prompt recognition, which is hindered by variation among published severity criteria. Our aim was to test the performance of different severity scores in predicting mortality among a cohort of hospital inpatients with sepsis.
We anonymously linked routine outcome data to a cohort of prospectively identified adult hospital inpatients with sepsis, and used logistic regression to identify associations between mortality and demographic variables, clinical factors including blood culture results, and six sets of severity criteria. We calculated performance characteristics, including area under receiver operating characteristic curves (AUROC), of each set of severity criteria in predicting mortality.
Overall mortality was 19.4% (124/640) at 30 days after sepsis onset. In adjusted analysis, older age (odds ratio 5.79 (95% CI 2.87-11.70) for ≥80y versus <60y), having been admitted as an emergency (OR 3.91 (1.31-11.70) versus electively), and longer inpatient stay prior to sepsis onset (OR 2.90 (1.41-5.94) for >21d versus <4d), were associated with increased 30 day mortality. Being in a surgical or orthopaedic, versus medical, ward was associated with lower mortality (OR 0.47 (0.27-0.81) and 0.26 (0.11-0.63), respectively). Blood culture results (positive vs. negative) were not significantly association with mortality. All severity scores predicted mortality but performance varied. The CURB65 community-acquired pneumonia severity score had the best performance characteristics (sensitivity 81%, specificity 52%, positive predictive value 29%, negative predictive value 92%, for 30 day mortality), including having the largest AUROC curve (0.72, 95% CI 0.67-0.77).
The CURB65 pneumonia severity score outperformed five other severity scores in predicting risk of death among a cohort of hospital inpatients with sepsis. The utility of the CURB65 score for risk-stratifying patients with sepsis in clinical practice will depend on replicating these findings in a validation cohort including patients with sepsis on admission to hospital.
Additional file 1: Table S1: SEWS score detail.pdf contains a table entitled “Standardised early warning system (SEWS) scores allocated for each clinical observation” giving additional information on this scoring system with the relevant reference from the literature. (PDF 299 KB)
Additional file 2: Table S2: Classification of blood culture isolates.pdf contains a table entitled “Classification of all organisms isolated from blood cultures in study patients” in which isolated organisms are classified into whether they are likely pathogens or contaminants. (PDF 175 KB)
Additional file 3: Table S3: AUROC curves with extra variables.pdf contains a table entitled “AUROC curves for severity criteria created by adding further clinical variables to the CURB65 score” demonstrating changes made to the area under receiver operating characteristics curves made by adding clinical variables to the CURB65 score for community acquired pneumonia. (PDF 181 KB)
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- Identifying which septic patients have increased mortality risk using severity scores: a cohort study
Charis A Marwick
Jan EC Pringle
Shaun R McLeod
Josie MM Evans
Peter G Davey
- BioMed Central
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