Comparison of severity score models based on different sepsis definitions to predict in-hospital mortality among sepsis patients in the Intensive Care Unit

Abstract

Objective: A comparison is made of the accuracy between severity models, based on different sepsis definitions (systemic inflammatory response syndrome (SIRS), predisposition, insult, response, organ dysfunction (PIRO), and sequential organ failure assessment (SOFA) concepts), in predicting outcomes among sepsis patients.

Design: A retrospective study was carried out.

Setting: The study was conducted in the Intensive Care Unit (ICU) of a university teaching hospital.

Patients: Septic patients admitted to the ICU during 2007-2016.

Main variables of interest: The primary outcome was in-hospital mortality, with ICU mortality being the secondary outcome.

Results: A total of 2152 septic patient were identified, with ICU and in-hospital mortality rates of 33.3% and 45.9%, respectively. The Moreno PIRO (AUC, 95%CI) (0.835; 0.818-0.852) showed the highest discriminating capacity, followed by SOFA (0.828; 0.811-0.846), qSOFA (0.792; 0.775-0.809), Rubulotta PIRO (0.708; 0.687-0.730), Howell PIRO (0.706; 0.685-0.728) and SIRS (0.578; 0.556-0.600). The AUC of the SOFA score was comparable to that of the Moreno PIRO (p=0.43), though the AUCs of both of these scores were significantly higher than those of the other scores (p<0.001 for all other comparisons). However, the SOFA score showed the best discriminating capacity in predicting ICU mortality (0.838; 0.820-0.855), followed by Moreno PIRO (0.804; 0.785-0.823) and qSOFA (0.787; 0.770-0.805). The accuracy of the qSOFA in predicting ICU mortality was comparable to that of the Moreno PIRO score (p=0.15).

Conclusion: The SOFA score and Moreno PIRO score showed the best accuracy in predicting in-hospital mortality among septic patients admitted to the ICU.

Keywords: Evaluación del fallo orgánico secuencial; Outcome; Predisposición, lesión, respuesta, disfunción orgánica; Predisposition, insult, response, organ dysfunction; Resultado; Septic shock; Sequential organ failure assessment; Shock séptico; Systemic inflammatory response syndrome; Síndrome de respuesta inflamatoria sistémica.