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. 2023 May 1;59(5):702-707.
doi: 10.1097/SHK.0000000000002112. Epub 2023 Mar 8.

CHARACTERISTICS AND PREDICTORS OF PATIENTS WITH SEPSIS WHO ARE CANDIDATES FOR MINIMALLY INVASIVE APPROACH OUTSIDE OF INTENSIVE CARE UNIT

Abdul Wahab  1 , Ryan J Smith  2 , Amos Lal  3 , Laure Flurin, Michael Malinchoc  4 , Yue Dong  5 , Ognjen Gajic  3
Affiliations

CHARACTERISTICS AND PREDICTORS OF PATIENTS WITH SEPSIS WHO ARE CANDIDATES FOR MINIMALLY INVASIVE APPROACH OUTSIDE OF INTENSIVE CARE UNIT

Abdul Wahab et al. Shock. .

Abstract

Objective: To identify and describe characteristics of patients with sepsis who could be treated with minimally invasive sepsis (MIS) approach without intensive care unit (ICU) admission and to develop a prediction model to select candidates for MIS approach. Methods: A secondary analysis of the electronic database of patients with sepsis at Mayo Clinic, Rochester, MN. Candidates for the MIS approach were adults with septic shock and less than 48 hours of ICU stay, who did not require advanced respiratory support and were alive at hospital discharge. Comparison group consisted of septic shock patients with an ICU stay of more than 48 hours without advanced respiratory support at the time of ICU admission. Results: Of 1795 medical ICU admissions, 106 patients (6%) met MIS approach criteria. Predictive variables (age >65 years, oxygen flow >4 L/min, temperature <37°C, creatinine >1.6 mg/dL, lactate >3 mmol/L, white blood cells >15 × 10 9 /L, heart rate >100 beats/min, and respiration rate >25 breaths/min) selected through logistic regression were translated into an 8-point score. Model discrimination yielded the area under the receiver operating characteristic curve of 79% and was well fitted (Hosmer-Lemeshow P = 0.94) and calibrated. The MIS score cutoff of 3 resulted in a model odds ratio of 0.15 (95% confidence interval, 0.08-0.28) and a negative predictive value of 91% (95% confidence interval, 88.69-92.92). Conclusions: This study identifies a subset of low-risk septic shock patients who can potentially be managed outside the ICU. Once validated in an independent, prospective sample our prediction model can be used to identify candidates for MIS approach.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

FIG. 1
FIG. 1
Flow chart of inclusion and exclusion criteria. CCU, coronary care unit; ICU, intensive care unit; MICU, medical intensive care unit; NCC, neuro critical care; SICUs, surgical intensive care units.
FIG. 2
FIG. 2
Receiver operating characteristic curve for predicting candidates for minimally invasive approach.
FIG. 3
FIG. 3
Model calibration: predicted versus observed proportions for each point of minimally invasive sepsis score.
See this image and copyright information in PMC

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