Hypoalbuminemia, Low Base Excess Values, and Tachypnea Predict 28-Day Mortality in Severe Sepsis and Septic Shock Patients in the Emergency Department.
10.3349/ymj.2016.57.6.1361
- Author:
Min Ho SEO
1
;
Minhong CHOA
;
Je Sung YOU
;
Hye Sun LEE
;
Jung Hwa HONG
;
Yoo Seok PARK
;
Sung Phil CHUNG
;
Incheol PARK
Author Information
1. Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. pys905@yuhs.ac
- Publication Type:Original Article
- Keywords:
Severe sepsis;
septic shock;
mortality;
nomograms
- MeSH:
Area Under Curve;
Biomarkers;
Discrimination (Psychology);
Emergencies*;
Emergency Service, Hospital*;
Humans;
Hypoalbuminemia*;
Mortality*;
Multivariate Analysis;
Nomograms;
Respiratory Rate;
ROC Curve;
Sepsis*;
Shock, Septic*;
Tachypnea*;
Vital Signs
- From:Yonsei Medical Journal
2016;57(6):1361-1369
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The objective of this study was to develop a new nomogram that can predict 28-day mortality in severe sepsis and/or septic shock patients using a combination of several biomarkers that are inexpensive and readily available in most emergency departments, with and without scoring systems. MATERIALS AND METHODS: We enrolled 561 patients who were admitted to an emergency department (ED) and received early goal-directed therapy for severe sepsis or septic shock. We collected demographic data, initial vital signs, and laboratory data sampled at the time of ED admission. Patients were randomly assigned to a training set or validation set. For the training set, we generated models using independent variables associated with 28-day mortality by multivariate analysis, and developed a new nomogram for the prediction of 28-day mortality. Thereafter, the diagnostic accuracy of the nomogram was tested using the validation set. RESULTS: The prediction model that included albumin, base excess, and respiratory rate demonstrated the largest area under the receiver operating characteristic curve (AUC) value of 0.8173 [95% confidence interval (CI), 0.7605–0.8741]. The logistic analysis revealed that a conventional scoring system was not associated with 28-day mortality. In the validation set, the discrimination of a newly developed nomogram was also good, with an AUC value of 0.7537 (95% CI, 0.6563–0.8512). CONCLUSION: Our new nomogram is valuable in predicting the 28-day mortality of patients with severe sepsis and/or septic shock in the emergency department. Moreover, our readily available nomogram is superior to conventional scoring systems in predicting mortality.
