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Choi JS, Trinh TX, Ha J, Yang MS, Lee Y, Kim YE, Choi J, Byun HG, Song J, Yoon TH. Implementation of Complementary Model using Optimal Combination of Hematological Parameters for Sepsis Screening in Patients with Fever. Sci Rep 2020; 10:273. [PMID: 31937825 PMCID: PMC6959355 DOI: 10.1038/s41598-019-57107-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/27/2019] [Indexed: 12/29/2022] Open
Abstract
The early detection and timely treatment are the most important factors for improving the outcome of patients with sepsis. Sepsis-related clinical score, such as SIRS, SOFA and LODS, were defined to identify patients with suspected infection and to predict severity and mortality. A few hematological parameters associated with organ dysfunction and infection were included in the score although various clinical pathology parameters (hematology, serum chemistry and plasma coagulation) in blood sample have been found to be associated with outcome in patients with sepsis. The investigation of the parameters facilitates the implementation of a complementary model for screening sepsis to existing sepsis clinical criteria and other laboratory signs. In this study, statistical analysis on the multiple clinical pathology parameters obtained from two groups, patients with sepsis and patients with fever, was performed and the complementary model was elaborated by stepwise parameter selection and machine learning. The complementary model showed statistically better performance (AUC 0.86 vs. 0.74–0.51) than models built up with specific hematology parameters involved in each existing sepsis-related clinical score. Our study presents the complementary model based on the optimal combination of hematological parameters for sepsis screening in patients with fever.
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Affiliation(s)
- Jang-Sik Choi
- Center for Next Generation Cytometry, Hanyang University, Seoul, 04763, Republic of Korea.,Department of Chemistry, College of Natural Sciences, Hanyang University, Seoul, 04763, Republic of Korea.,Institute of Next Generation Material Design, Hanayng University, Seoul, 04763, Republic of Korea
| | - Tung X Trinh
- Center for Next Generation Cytometry, Hanyang University, Seoul, 04763, Republic of Korea.,Department of Chemistry, College of Natural Sciences, Hanyang University, Seoul, 04763, Republic of Korea
| | - Jihye Ha
- Department of Laboratory Medicine, College of Medicine, Yonsei University, Seoul, 03722, Republic of Korea
| | - Mi-Sook Yang
- Department of Laboratory Medicine, College of Medicine, Yonsei University, Seoul, 03722, Republic of Korea
| | - Yangsoon Lee
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Yeoung-Eun Kim
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Jungsoon Choi
- Department of Mathematics, College of Natural Sciences, Hanyang University, Seoul, 04763, Republic of Korea
| | - Hyung-Gi Byun
- Division of Electronics, Information and Communication Engineering, Kangwon National University, Kangwon-Do, 25913, Republic of Korea
| | - Jaewoo Song
- Department of Laboratory Medicine, College of Medicine, Yonsei University, Seoul, 03722, Republic of Korea.
| | - Tae-Hyun Yoon
- Center for Next Generation Cytometry, Hanyang University, Seoul, 04763, Republic of Korea. .,Department of Chemistry, College of Natural Sciences, Hanyang University, Seoul, 04763, Republic of Korea. .,Institute of Next Generation Material Design, Hanayng University, Seoul, 04763, Republic of Korea.
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Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock. J Crit Care 2014; 30:97-101. [PMID: 25269788 DOI: 10.1016/j.jcrc.2014.09.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/22/2014] [Accepted: 09/01/2014] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study is to assess whether late positive fluid balances are associated with acute kidney injury and mortality in severe sepsis and septic shock. METHODS In this retrospective study, fluid balances were calculated at 3 different time points: the onset of organ dysfunction attributed to sepsis, sepsis diagnosis, and vasopressors initiation. Data were analyzed in logistic regression models for mortality and acute kidney injury as outcomes. RESULTS We included 116 patients. A RIFLE score F, diuresis less than 0.9 L from the second day after the first organ dysfunction, and fluid balance more than 3 L between the 24th and the 48th hour after diagnosis were independently associated with higher mortality, whereas in the subgroup with shock, only the latter parameter and diuresis less than 0.85 L on the first day of shock were independent risk factors. After adjusting for age, creatinine more than 1.2 mg/dL, a nonrenal Sequential Organ Failure Assessment greater than or equal to 7.5 on the first day and urine output less than 1.3 L on the first day after organ dysfunction were independent risk factors for RIFLE F. No relationship was found between fluid balance and acute kidney injury. CONCLUSION Late positive fluid balance is an independent risk factor for mortality in severe sepsis. Positive fluid balances are not associated with either protection against or risk for acute kidney injury.
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