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Comparative Study
. 2020 Jan-Dec:34:2058738420936386.
doi: 10.1177/2058738420936386.

External validation of the sepsis severity score

Marek Wełna  1 , Barbara Adamik  1 , Waldemar Goździk  1 , Andrzej Kübler  1
Affiliations
Comparative Study

External validation of the sepsis severity score

Marek Wełna et al. Int J Immunopathol Pharmacol. 2020 Jan-Dec.

Abstract

Introduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Mortality rates are high, exceeding 50% in patients with septic shock. The sepsis severity score (SSS) was developed to determine the severity of sepsis and as a prognostic model. The aim of this study was to externally validate the SSS model.

Methods: Calibration and discrimination of the SSS were retrospectively evaluated using data from a single-center sepsis registry.

Results: Data from 156 septic patients were recorded; 56% of them had septic shock, 94% of patients required mechanical ventilation. The observed hospital mortality was 60.3%. The mean SSS value was 94.4 (95% CI 90.5-98.3). The SSS presented excellent discrimination with an area under the receiver operating characteristic curve (AUC) of 0.806 (95% CI 0.734-0.866). The pairwise comparison of APACHE II (AUC = 0.789; 95% CI 0.715-0.851) with SSS and 1st day SOFA (AUC = 0.75; 95% CI 0.673-0.817) with SSS revealed no significant differences in discrimination between the models. The calibration of the SSS was good with the Hosmer-Lemeshow goodness-of-fit H test 9.59, P > 0.05. Analyses of calibration curve show absence of accurate predictions in lower deciles of lower risk (2nd and 4th).

Conclusion: The SSS demonstrated excellent discrimination. The calibration evaluation gave conflicting results; the H-L test result indicated a good calibration, while the visual analysis of the calibration curve suggested the opposite. The SSS requires further evaluation before it can be safely recommended as an outcome prediction model.

Keywords: hospital mortality; humans; prognosis; sepsis/mortality; survival analysis.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Receiver operating characteristic curves for prediction of the likelihood of death in patients with sepsis and septic shock. Sepsis severity score, APACHE II score, and 1st day SOFA score had areas under the ROC curve of 0.8060, 0.789, and 0.750, respectively.
Figure 2.
Figure 2.
The SSS calibration curve. The comparison of observed versus predicted mortality in the deciles of predicted mortality.
See this image and copyright information in PMC

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References

    1. Fleischmann C, Scherag A, Adhikari NKJ, et al. (2016) Assessment of global incidence and mortality of hospital-treated sepsis. Current Estimates and Limitations. The American Journal of Respiratory and Critical Care Medicine 193: 259–272. - PubMed
    1. Dombrovskiy VY, Martin AA, Sunderram J, et al. (2005) Facing the challenge: Decreasing case fatality rates in severe sepsis despite increasing hospitalizations. Critical Care Medicine 33(11): 2555–2562. - PubMed
    1. Melamed A, Sorvillo FJ. (2009) The burden of sepsis-associated mortality in the United States from1999 to 2005: An analysis of multiple-cause data. Critical Care 13: R28. - PMC - PubMed
    1. Martin GS, Mannino DM, Eaton S, et al. (2003) The epidemiology of sepsis in the United States from 1979 through 2000. The New England Journal of Medicine 348: 1546–1554. - PubMed
    1. Stoller J, Halpin L, Weis M, et al. (2016) Epidemiology of severe sepsis: 2008-2012. Journal of Critical Care 31(1): 58–62. - PubMed

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