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Rahman MS, Islam KR, Prithula J, Kumar J, Mahmud M, Alam MF, Reaz MBI, Alqahtani A, Chowdhury MEH. Machine learning-based prognostic model for 30-day mortality prediction in Sepsis-3. BMC Med Inform Decis Mak 2024; 24:249. [PMID: 39251962 PMCID: PMC11382400 DOI: 10.1186/s12911-024-02655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Sepsis poses a critical threat to hospitalized patients, particularly those in the Intensive Care Unit (ICU). Rapid identification of Sepsis is crucial for improving survival rates. Machine learning techniques offer advantages over traditional methods for predicting outcomes. This study aimed to develop a prognostic model using a Stacking-based Meta-Classifier to predict 30-day mortality risks in Sepsis-3 patients from the MIMIC-III database. METHODS A cohort of 4,240 Sepsis-3 patients was analyzed, with 783 experiencing 30-day mortality and 3,457 surviving. Fifteen biomarkers were selected using feature ranking methods, including Extreme Gradient Boosting (XGBoost), Random Forest, and Extra Tree, and the Logistic Regression (LR) model was used to assess their individual predictability with a fivefold cross-validation approach for the validation of the prediction. The dataset was balanced using the SMOTE-TOMEK LINK technique, and a stacking-based meta-classifier was used for 30-day mortality prediction. The SHapley Additive explanations analysis was performed to explain the model's prediction. RESULTS Using the LR classifier, the model achieved an area under the curve or AUC score of 0.99. A nomogram provided clinical insights into the biomarkers' significance. The stacked meta-learner, LR classifier exhibited the best performance with 95.52% accuracy, 95.79% precision, 95.52% recall, 93.65% specificity, and a 95.60% F1-score. CONCLUSIONS In conjunction with the nomogram, the proposed stacking classifier model effectively predicted 30-day mortality in Sepsis patients. This approach holds promise for early intervention and improved outcomes in treating Sepsis cases.
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Affiliation(s)
- Md Sohanur Rahman
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Khandaker Reajul Islam
- Department of Physiology, Faculty of Medicine, University Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Johayra Prithula
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Jaya Kumar
- Department of Physiology, Faculty of Medicine, University Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Mufti Mahmud
- Department of Computer Science, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, UK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar
| | - Mamun Bin Ibne Reaz
- Department of Electrical Engineering, Independent University, Bangladesh, Dhaka, Bangladesh
| | - Abdulrahman Alqahtani
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City, 11952, Saudi Arabia
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Luka S, Golea A, Vesa ȘC, Leahu CE, Zăgănescu R, Ionescu D. Can We Improve Mortality Prediction in Patients with Sepsis in the Emergency Department? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1333. [PMID: 39202614 PMCID: PMC11356275 DOI: 10.3390/medicina60081333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Sepsis represents a global health challenge and requires advanced diagnostic and prognostic approaches due to its elevated rate of morbidity and fatality. Our study aimed to assess the value of a novel set of six biomarkers combined with severity scores in predicting 28 day mortality among patients presenting with sepsis in the Emergency Department (ED). Materials and Methods: This single-center, observational, prospective cohort included sixty-seven consecutive patients with septic shock and sepsis enrolled from November 2020 to December 2022, categorized into survival and non-survival groups based on outcomes. The following were assessed: procalcitonin (PCT), soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1), the soluble form of the urokinase plasminogen activator receptor (suPAR), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and azurocidin 1 (AZU1), alongside clinical scores such as the Quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), the Sequential Organ Failure Assessment (SOFA), the Acute Physiology and Chronic Health Evaluation II (APACHE II), the Simplified Acute Physiology Score II and III (SAPS II/III), the National Early Warning Score (NEWS), Mortality in Emergency Department Sepsis (MEDS), the Charlson Comorbidity Index (CCI), and the Glasgow Coma Scale (GCS). The ability of each biomarker and clinical score and their combinations to predict 28 day mortality were evaluated. Results: The overall mortality was 49.25%. Mechanical ventilation was associated with a higher mortality rate. The levels of IL-6 were significantly higher in the non-survival group and had higher AUC values compared to the other biomarkers. The GCS, SOFA, APACHEII, and SAPS II/III showed superior predictive ability. Combining IL-6 with suPAR, AZU1, and clinical scores SOFA, APACHE II, and SAPS II enhanced prediction accuracy compared with individual biomarkers. Conclusion: In our study, IL-6 and SAPS II/III were the most accurate predictors of 28 day mortality for sepsis patients in the ED.
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Affiliation(s)
- Sonia Luka
- Department 6 Surgery, Discipline of Emergency Medicine, Iuliu Hatieganu, Faculty of Medicine, University of Medicine and Pharmacy, 3–5 Clinicilor Street, 400347 Cluj-Napoca, Romania;
- Clinical Emergency County Hospital, 3–5 Clinicilor Street, 400347 Cluj-Napoca, Romania; (C.-E.L.); (R.Z.)
| | - Adela Golea
- Department 6 Surgery, Discipline of Emergency Medicine, Iuliu Hatieganu, Faculty of Medicine, University of Medicine and Pharmacy, 3–5 Clinicilor Street, 400347 Cluj-Napoca, Romania;
- Clinical Emergency County Hospital, 3–5 Clinicilor Street, 400347 Cluj-Napoca, Romania; (C.-E.L.); (R.Z.)
| | - Ștefan Cristian Vesa
- Department 1 Functional Sciences, Discipline of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania;
| | - Crina-Elena Leahu
- Clinical Emergency County Hospital, 3–5 Clinicilor Street, 400347 Cluj-Napoca, Romania; (C.-E.L.); (R.Z.)
| | - Raluca Zăgănescu
- Clinical Emergency County Hospital, 3–5 Clinicilor Street, 400347 Cluj-Napoca, Romania; (C.-E.L.); (R.Z.)
| | - Daniela Ionescu
- Department 6 Surgery, Discipline of Anesthesia and Intensive Care I, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 19–21 Croitorilor Street, 400162 Cluj-Napoca, Romania;
- Department of Anesthesia and Intensive Care, The Regional Institute of Gastroenterology and Hepatology, “Prof. Dr. Octavian Fodor”, 19–21 Croitorilor Street, 400162 Cluj-Napoca, Romania
- Research Association in Anesthesia and Intensive Care (ACATI), 400394 Cluj-Napoca, Romania
- Outcome Research Consortium, Cleveland, OH 44195, USA
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Oh N, Cha WC, Seo JH, Choi SG, Kim JM, Chung CR, Suh GY, Lee SY, Oh DK, Park MH, Lim CM, Ko RE. ChatGPT Predicts In-Hospital All-Cause Mortality for Sepsis: In-Context Learning with the Korean Sepsis Alliance Database. Healthc Inform Res 2024; 30:266-276. [PMID: 39160785 PMCID: PMC11333818 DOI: 10.4258/hir.2024.30.3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES Sepsis is a leading global cause of mortality, and predicting its outcomes is vital for improving patient care. This study explored the capabilities of ChatGPT, a state-of-the-art natural language processing model, in predicting in-hospital mortality for sepsis patients. METHODS This study utilized data from the Korean Sepsis Alliance (KSA) database, collected between 2019 and 2021, focusing on adult intensive care unit (ICU) patients and aiming to determine whether ChatGPT could predict all-cause mortality after ICU admission at 7 and 30 days. Structured prompts enabled ChatGPT to engage in in-context learning, with the number of patient examples varying from zero to six. The predictive capabilities of ChatGPT-3.5-turbo and ChatGPT-4 were then compared against a gradient boosting model (GBM) using various performance metrics. RESULTS From the KSA database, 4,786 patients formed the 7-day mortality prediction dataset, of whom 718 died, and 4,025 patients formed the 30-day dataset, with 1,368 deaths. Age and clinical markers (e.g., Sequential Organ Failure Assessment score and lactic acid levels) showed significant differences between survivors and non-survivors in both datasets. For 7-day mortality predictions, the area under the receiver operating characteristic curve (AUROC) was 0.70-0.83 for GPT-4, 0.51-0.70 for GPT-3.5, and 0.79 for GBM. The AUROC for 30-day mortality was 0.51-0.59 for GPT-4, 0.47-0.57 for GPT-3.5, and 0.76 for GBM. Zero-shot predictions using GPT-4 for mortality from ICU admission to day 30 showed AUROCs from the mid-0.60s to 0.75 for GPT-4 and mainly from 0.47 to 0.63 for GPT-3.5. CONCLUSIONS GPT-4 demonstrated potential in predicting short-term in-hospital mortality, although its performance varied across different evaluation metrics.
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Affiliation(s)
- Namkee Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jun Hyuk Seo
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul,
Korea
| | - Seong-Gyu Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul,
Korea
| | - Su Yeon Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Dong Kyu Oh
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Mi Hyeon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Chae-Man Lim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
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Tang J, Zhao P, Li Y, Liu S, Chen L, Chen Y, Chen R, Shen Y, Liu Y. The relationship between potassium levels and 28-day mortality in sepsis patients: Secondary data analysis using the MIMIC-IV database. Heliyon 2024; 10:e31753. [PMID: 38845906 PMCID: PMC11154597 DOI: 10.1016/j.heliyon.2024.e31753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Objective The goal of the research is to investigate the link between serum potassium levels and death after 28 days in sepsis patients, utilizing an extensive sample of patients from the multi-center Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Current research on serum potassium levels and 28-day mortality in sepsis patients is questionable. This study adds to the growing body of evidence linking serum potassium levels to the 28-day possibility of death in patients with sepsis. Methods We collected 349,08 patients with sepsis from the retrospective cohort MIMIC-IV database, using serum potassium level on the first day of admission to the intensive care unit as the exposure variable and mortality at 28 days as the outcome variable. And controlled for confounding characteristics including gender, age, ethnicity, and vital signs during admission. Results Serum potassium has a U-shaped connection with 28-day mortality in patients suffering from sepsis. The turning point was 4.10 mmol/L (95 % confidence interval: 4.03 to 4.22). Serum potassium and 28-day mortality were negatively linked on the inflection point's left side (OR: 0.72; 95 % CI: 0.63 to 0.83, P < 0.0001); on the opposing side of the point of inflexion, serum potassium was enthusiastically attached to 28-day mortality. (OR: 1.13; 95 % CI: 1.06 to 1.21, P < 0.0001). Conclusion The research conducted found that too high or too low potassium levels were linked to a 28-day risk of mortality in humans with sepsis.
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Affiliation(s)
- Juan Tang
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
- School of Clinical Laboratory Science, Guizhou Medical University, 9 Beijing Road, Guiyang, Guizhou, China
| | - Peiling Zhao
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
| | - Yi Li
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
- School of Clinical Laboratory Science, Guizhou Medical University, 9 Beijing Road, Guiyang, Guizhou, China
| | - Shaowen Liu
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
- School of Clinical Laboratory Science, Guizhou Medical University, 9 Beijing Road, Guiyang, Guizhou, China
| | - Lu Chen
- Department of Clinical Trials Centre, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
| | - Yu Chen
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
| | - Rui Chen
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
| | - Yong Shen
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
| | - Yongmei Liu
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, 28, Guiyi Street, Guiyang, Guizhou, China
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Qian W, Han C, Xie S, Xu S. Prediction model of death risk in patients with sepsis and screening of biomarkers for prognosis of patients with myocardial injury. Heliyon 2024; 10:e27209. [PMID: 38449610 PMCID: PMC10915407 DOI: 10.1016/j.heliyon.2024.e27209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
This study aimed to create a robust prediction model for sepsis patient mortality and identify key biomarkers in those with myocardial injury. A retrospective analysis of 261 sepsis inpatients was conducted, with 44 deaths and 217 recoveries. Key factors were assessed via univariate and multivariate analyses, revealing myocardial injury, shock, and pulmonary infection as independent mortality risk factors. Using LASSO regression, a reliable prediction model was developed and internally validated. Additionally, procalcitonin (PCT) emerged as a sensitive biomarker for myocardial injury prediction in sepsis patients. In summary, this study highlights myocardial injury, shock, and pulmonary infection as independent risk factors for sepsis-related deaths. The LASSO-based prediction model effectively forecasts the prognosis of septic patients with myocardial injury, with PCT showing promise as a predictive biomarker.
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Affiliation(s)
- Weiwei Qian
- Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdou, 610041, PR China
- Shangjinnanfu Hospital, West China Hospital, Sichuan University, PR China
| | - Cunqiao Han
- Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdou, 610041, PR China
- Shangjinnanfu Hospital, West China Hospital, Sichuan University, PR China
| | - Shenglong Xie
- Department of Thoracic Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdou, 610041, PR China
| | - Shuyun Xu
- Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdou, 610041, PR China
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Li S, Zhang W, Liang B, Huang W, Luo C, Zhu Y, Kou KI, Ruan G, Liu L, Zhang G, Li H. A Rulefit-based prognostic analysis using structured MRI report to select potential beneficiaries from induction chemotherapy in advanced nasopharyngeal carcinoma: A dual-centre study. Radiother Oncol 2023; 189:109943. [PMID: 37813309 DOI: 10.1016/j.radonc.2023.109943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/12/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND PURPOSE Structured MRI report facilitate prognostic prediction for nasopharyngeal carcinoma (NPC). However, the intrinsic association among structured variables is not fully utilised. This study aimed to investigate the performance of a Rulefit-based model in feature integration behind structured MRI report and prognostic prediction in advanced NPC. MATERIALS AND METHODS We retrospectively enrolled 1207 patients diagnosed with non-metastatic advanced NPC from two centres, and divided into training (N = 544), internal testing (N = 367), and external testing (N = 296) cohorts. Machine learning algorithms including multivariate analysis, deep learning, Lasso, and Rulefit were used to establish corresponding prognostic models. The concordance indices (C- indices) of three clinical and six combined models with different algorithms for overall survival (OS) prediction were compared. Survival benefits of induction chemotherapy (IC) were calculated among risk groups stratified by different models. A website was established for individualised survival visualisation. RESULTS Incorporating structured variables into Stage model significantly improved the prognostic prediction performance. Six prognostic rules with structured variables were identified by Rulefit. OS prediction of Rules model was comparable to Lasso model in internal testing cohort (C-index: 0.720 vs. 0.713, P = 0.100) and achieved the highest C-index of 0.711 in external testing cohort, indicating better generalisability. The Rules model stratified patients into risk groups with significant 5-year OS differences in each cohort, and revealed significant survival benefits from additional IC in high-risk group. CONCLUSION The Rulefit-based Rules model, with the revelation of intrinsic associations behind structured variables, is promising in risk stratification and guiding individualised IC treatment for advanced NPC.
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Affiliation(s)
- Shuqi Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China
| | - Weijing Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China
| | - Baodan Liang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China
| | - Wenjie Huang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China
| | - Chao Luo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China
| | - Yuliang Zhu
- Nasopharyngeal Head-and-Neck Tumor Radiotherapy Department, Zhongshan City People's Hospital, China
| | - Kit Ian Kou
- Department of Mathematics, Faculty of Science and Technology, University of Macau, China
| | - Guangying Ruan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China
| | - Guoyi Zhang
- Cancer center, the First People's Hospital of Foshan, Foshan 528000, Guangdong, China.
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China.
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Chen P, Gao J, Li J, Yu R, Wang L, Xue F, Zheng X, Gao L, Shang X. Construction and efficacy evaluation of an early warning scoring system for septic shock in patients with digestive tract perforation: A retrospective cohort study. Front Med (Lausanne) 2022; 9:976963. [PMID: 36177334 PMCID: PMC9513145 DOI: 10.3389/fmed.2022.976963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo establish an early warning scoring system for septic shock in patients with digestive tract perforation (DTP) and evaluate its diagnostic efficacy.MethodsPatients with surgically confirmed or clinically diagnosed DTP admitted to the Department of Intensive Care Medicine of Fujian Provincial Hospital from June 2012 to October 2021 were retrospectively analyzed. General demographic characteristics, perforation-related information, vital signs, common laboratory indicators, and common ICU scores (Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation-II score,Sequential Organ Failure Assessment score) were collected. The patients were divided into shock group and non-shock group according to whether the patients had septic shock during hospitalization. The risk factors of septic shock were screened by basic statistical analysis and multivariate Logistic regression analysis. The receiver operating characteristic curve was drawn to determine the cut-off value of the continuous indicators and discretized with reference to clinic, and the corresponding score was set according to the β regression coefficient of each variable.ResultsA total of 176 patients with DTP were included. The average age of the patients was 64.13 ± 14.67 years old, and 74.40% were males. The incidence of septic shock was 30.11% (53/176). Multivariate Logistic regression analysis showed that the highest heart rate≥105 beats/min, Glasgow Coma Scale score≤14 points, lactic acid≥5.75 mmol/L, procalcitonin≥41.47 ug/L, C-reactive protein≥222.5 mg/L were independent risk factors for septic shock in patients with DTP. The total score of clinical diagnostic scoring system of septic shock in patients with DTP was 6 points, including the highest heart rate≥105 beats/min (1 point), lactic acid≥5.75 mmol/L (two points), procalcitonin≥41.47 ug/L (one point), C-reactive protein≥222.5 mg/L (1 point), and Glasgow Coma Scale score≤14 points (1 point). The area under ROC curve (AUC) of this scoring system was 0.789 and the 95% confidence interval was 0.717–0.860 (P < 0.001); when the optimal cut-off value was 2.5, the sensitivity and specificity were 54.70 and 87.80%, respectively.ConclusionThis new score system has its certain clinical value and has important guiding significance for clinicians to judge the prognosis of patients with DTP in time.
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Affiliation(s)
- Peiling Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Jingqi Gao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Jun Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Rongguo Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Ling Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Fangqin Xue
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastrointestinal Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaochun Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Emergency Medical Center, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-constructed Laboratory of “Belt and Road,”Fuzhou, China
| | - Ling Gao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Xiuling Shang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- The Third Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
- *Correspondence: Xiuling Shang
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