A nomogram to predict 28-day mortality in neonates with sepsis: a retrospective study based on the MIMIC-III database
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PROVIDER: S-EPMC10560361 | biostudies-literature | 2023 Sep
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Project description:Background: Sepsis-induced coagulopathy (SIC) is a common cause for inducing poor prognosis of critically ill patients in intensive care unit (ICU). However, currently there are no tools specifically designed for assessing short-term mortality in SIC patients. This study aimed to develop a practical nomogram to predict the risk of 28-day mortality in SIC patients. Methods: In this retrospective cohort study, we extracted patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Sepsis was defined based on Sepsis 3.0 criteria and SIC based on Toshiaki Iba's criteria. Kaplan-Meier curves were plotted to compare the short survival time between SIC and non-SIC patients. Afterward, only SIC cohort was randomly divided into training or validation set. We employed univariate logistic regression and stepwise multivariate analysis to select predictive features. The proposed nomogram was developed based on multivariate logistic regression model, and the discrimination and calibration were verified by internal validation. We then compared model discrimination with other traditional severity scores and machine learning models. Results: 9432 sepsis patients in MIMIC III were enrolled, in which 3280 (34.8%) patients were diagnosed as SIC during the first ICU admission. SIC was independently associated with the 7- and 28-day mortality of ICU patients. K-M curve indicated a significant difference in 7-day (Log-Rank: P < 0.001 and P = 0.017) and 28-day survival (Log-Rank: P < 0.001 and P < 0.001) between SIC and non-SIC groups whether the propensity score match (PSM) was balanced or not. For nomogram development, a total of thirteen variables of 3,280 SIC patients were enrolled. When predicted the risk of 28-day mortality, the nomogram performed a good discrimination in training and validation sets (AUROC: 0.78 and 0.81). The AUROC values were 0.80, 0.81, 0.71, 0.70, 0.74, and 0.60 for random forest, support vector machine, sequential organ failure assessment (SOFA) score, logistic organ dysfunction score (LODS), simplified acute physiology II score (SAPS II) and SIC score, respectively, in validation set. And the nomogram calibration slope was 0.91, the Brier value was 0.15. As presented by the decision curve analyses, the nomogram always obtained more net benefit when compared with other severity scores. Conclusions: SIC is independently related to the short-term mortality of ICU patients. The nomogram achieved an optimal prediction of 28-day mortality in SIC patient, which can lead to a better prognostics assessment. However, the discriminative ability of the nomogram requires validation in external cohorts to further improve generalizability.
| S-EPMC8056034 | biostudies-literature
Project description:ObjectiveTo develop a nomogram for predicting the occurrence of sepsis-associated delirium (SAD).Materials and methodsData from a total of 642 patients were retrieved from the Medical Information Mart for Intensive Care (MIMIC III) database to build a prediction model. Multivariate logistic regression was performed to identify independent predictors and establish a nomogram to predict the occurrence of SAD. The performance of the nomogram was assessed in terms of discrimination and calibration by bootstrapping with 1000 resamples.ResultsMultivariate logistic regression identified 4 independent predictors for patients with SAD, including Sepsis-related Organ Failure Assessment(SOFA) (p = 0.004; OR: 1.131; 95% CI 1.040 to 1.231), mechanical ventilation (P < 0.001; OR: 3.710; 95% CI 2.452 to 5.676), phosphate (P = 0.047; OR: 1.165; 95% CI 1.003 to 1.358), and lactate (P = 0.023; OR: 1.135; 95% CI 1.021 to 1.270) within 24 h of intensive care unit (ICU) admission. The area under the curve (AUC) of the predictive model was 0.742 in the training set and 0.713 in the validation set. The Hosmer - Lemeshow test showed that the model was a good fit (p = 0.471). The calibration curve of the predictive model was close to the ideal curve in both the training and validation sets. The DCA curve also showed that the predictive nomogram was clinically useful.ConclusionWe constructed a nomogram for the personalized prediction of delirium in sepsis patients, which had satisfactory performance and clinical utility and thus could help clinicians identify patients with SAD in a timely manner, perform early intervention, and improve their neurological outcomes.
| S-EPMC10503010 | biostudies-literature
Project description:BackgroundThis research focused on evaluating the correlation between platelet count and sepsis prognosis, and even the dose-response relationship, in a cohort of American adults.MethodPlatelet counts were recorded retrospectively after hospitalization for patients admitted to Beth Israel Deaconess Medical Center's intensive care unit between 2008 and 2019. On admission to the intensive care unit, sepsis patients were divided into four categories based on platelet counts (very low < 50 × 109/L, intermediate-low 50 × 109-100 × 109/L, low 100 × 109-150 × 109/L, and normal ≥ 150 × 109/L). A multivariate Cox proportional risk model was used to calculate the 28-day risk of mortality in sepsis based on baseline platelet counts, and a two-piece linear regression model was used to calculate the threshold effect.ResultsThe risk of 28-day septic mortality was nearly 2-fold higher in the platelet very low group when compared to the low group (hazard ratios [HRs], 2.24; 95% confidence interval [CI], 1.92-2.6). Further analysis revealed a curvilinear association between platelets and the sepsis risk of death, with a saturation effect predicted at 100 × 109/L. When platelet counts were below 100 × 109/L, the risk of sepsis 28-day death decreased significantly with increasing platelet count levels (HR, 0.875; 95% CI, 0.84-0.90).ConclusionWhen platelet count was less than 100 × 109/L, it was a strong predictor of the potential risk of sepsis death, which is declined by 13% for every 10 × 109/L growth in platelets. When platelet counts reach up to 100 × 109/L, the probability of dying to sepsis within 28 days climbs by 1% for every 10 × 109/L increase in platelet count.
| S-EPMC9021789 | biostudies-literature
Project description:IntroductionThis study aimed to explore the association of serum lactate with clinical outcomes in elderly patients with sepsis based on data from the MIMIC-IV database.MethodsAll elderly patients with sepsis (age ≥ 65 years) were included. Different models were constructed for exploring the relationships between lactate and 28-day mortality. A two-segment linear regression model was performed to verify the threshold effects of lactate on clinical outcomes and smooth curve fitting was performed.ResultsA total of 4199 elderly patients with sepsis were included. The 28-day mortality was 32.22% (n = 1395). After adjustment for all potential cofounders, for each 1 mmol/l increment in lactate, the odds ratio (OR) of 28-day mortality was 1.23 (95% CI 1.18-1.28, P < 0.0001). Smooth fitting curves indicated a non-linear positive relationship between lactate and 28-day mortality. The turning point of lactate level was 5.7 mmol/l: at ≤ 5.7 mmol/l, with each 1 mmol/l increment in lactate, the risk of 28-day mortality increased significantly (OR 1.32, 95% CI 1.25-1.38, P < 0.0001); the significantly positive relationship was still present at lactate > 5.7 mmol/l (OR 1.10, 95% CI 1.04-1.18, P = 0.0019). The area under the ROC curve (AUC) of lactate was 0.618 (95% CI 0.599-0.635) and the cutoff value of lactate was 2.4 mmol/l with a sensitivity of 0.483 and a specificity of 0.687.ConclusionIn elderly patients with sepsis, a non-linear positive relationship was discovered between serum lactate and 28-day mortality. Physicians should be alert to lactate assessment at admission and pay more attention to those patients with higher levels of lactate.
| S-EPMC9925625 | biostudies-literature
Project description:BackgroundThis study aims to assess the influence of early serum phosphate fluctuation on the short-term prognosis of sepsis patients.MethodsThis retrospective study used the Medical Information Mart for Intensive Care IV database to analyze serum phosphate levels in sepsis patients within 3 days of ICU admission. According to the absolute value of delta serum phosphate (the maximum value minus the minimum value of serum phosphorus measured within three days), the patients were divided into four groups, 0-1.3, 1.4-2.0, 2.1-3.1, and ≥ 3.2 mg/dl. Meanwhile, the direction of delta serum phosphate was compared. With the serum phosphate change group of 0-1.3 mg/dl as the reference group, the relationship between delta serum phosphate and in-hospital mortality and 28-day mortality was analyzed by multivariate Logistics regression analysis.ResultsThe study involved 1375 sepsis patients. Serum phosphate changes (0-1.3, 1.4-2.0, 2.1-3.1, and ≥ 3.2 mg/dl) correlated with in-hospital and 28-day mortality variations (p = 0.005, p = 0.008). Much higher serum phosphate fluctuation elevated in-hospital and 28-day mortality. Compared to the 0-1.3 mg/dl change group, adjusted odds ratios (OR) in other groups for in-hospital mortality were 1.25 (0.86-1.81), 1.28 (0.88-1.86), and 1.63 (1.10-2.43), and for 28-day mortality were 1.21 (0.86-1.72), 1.10 (0.77-1.57), and 1.49 (1.03-2.19). Under the trend of increasing serum phosphate, the ORs of in-hospital mortality and 28-day mortality in ≥ 3.2 mg/dl group were 2.52 and 2.01, respectively.ConclusionIn conclude, the delta serum phosphate ≥ 3.2 mg/dl was associated with in-hospital mortality and 28-day mortality in patients with sepsis.
| S-EPMC10898106 | biostudies-literature
Project description:BackgroundIn recent years, the hemoglobin, albumin, lymphocyte, and platelet (HALP) score has emerged as a potential marker of immunological and nutritional status. This study aimed to evaluate the association between the HALP score and prognosis in patients with sepsis.MethodsThis retrospective cohort study analyzed sepsis patients using clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were classified into Low-score and High-score groups. Confounding factors were controlled through propensity score matching (PSM) analysis. The primary outcome was 28-day mortality in individuals with sepsis. Survival probabilities between groups were compared using Kaplan-Meier curves. Multivariable Cox regression analysis and a smoothing spline fitting curve were employed to investigate the relationship between the HALP score and 28-day mortality. ROC curve analysis and subgroup analysis were performed to evaluate the predictive ability of the HALP score and its components.ResultsA total of 2,968 sepsis patients were included, with 809 (27.26%) deaths within 28 days. After PSM analysis, the High-score group had a 24% lower risk of 28-day mortality compared to the Low-score group (HR, 0.76; 95% CI, 0.64-0.91). In the unmatched cohort, the multivariable Cox regression model also indicated that the High-score group had a lower 28-day mortality risk (HR, 0.78; 95% CI, 0.67-0.91). The smoothing spline fitting curve showed a nonlinear relationship between the HALP score and 28-day mortality, with an inflection point at 24.69. When the HALP score was below 24.69, an increase of one point in the HALP score was associated with a 2% reduction in 28-day mortality (HR, 0.98; 95% CI, 0.97-0.99). The HALP score provided incremental predictive value for 28-day mortality when combined with the SOFA score. Albumin was identified as the most influential component of the HALP score.ConclusionAmong patients with sepsis, the HALP score exhibited a nonlinear relationship with 28-day mortality. An elevated HALP score is associated with reduced 28-day, 90-day, 360-day, and in-hospital mortality among sepsis patients.
| S-EPMC11892195 | biostudies-literature
Project description:Objective The relationship between base excess (BE) and 28-day death in sepsis patients remains to be elucidated. The aim of our clinical study is to explore the association of BE with 28-day mortality in patients with sepsis by using a large sample, multicenter Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Methods We extracted the data of 35,010 patients with sepsis from the MIMIC-IV database, in which we used BE as an exposure variable and the 28-day mortality as an outcome variable, respectively, so as to explore the impact of BE on the 28-day mortality of patients with sepsis after adjusting for covariates. Results BE and the 28-day mortality of patients with sepsis appeared to have a U-shaped relationship. The calculated inflection points were −2.5 mEq/L and 1.9 mEq/L, respectively. Our data demonstrated that BE was negatively associated with 28-day mortality in the range of −41.0 mEq/L to −2.5 mEq/L (odds ratio: 0.95; 95% confidence intervals (95%CI): 0.93 to 0.96), p < 0.0001. When BE was in the range of 1.9 mEq/L to 55.5 mEq/L, however, a positive association existed between BE and 28-day mortality of patients with sepsis (odds ratio: 1.03; 95% CI: 1.00 to 1.05; p < 0.05). Conclusion The BE levels have a U-shaped relationship with the 28-day mortality in patients with sepsis, in which the mortality of patients will gradually decrease with a BE value from −41.0 mEq/L to −2.5 mEq/L, while the mortality will increase with a BE value from 1.9 mEq/L to 55.5 mEq/L. Highlights • Base excess levels are closely associated with the probability of 28-day mortality in sepsis patients.• Base excess levels below −2.5 mEq/L and over 1.9 mEq/L are linked with 28-day all-cause mortality in individuals with sepsis.• The safe range of base excess for patients with sepsis in the hospital and ICU is −2.5 mEq/L to 1.9 mEq/L.
| S-EPMC10199177 | biostudies-literature
Project description:BackgroundSepsis is a life-threatening organ dysfunction due to disturbance of the host's response to infection, and is often accompanied by shock. Timely and standardized hemodynamic management can effectively control disease progression. Mean arterial pressure (MAP) refers to tissue and organ perfusion and is one of the key factors for patient recovery. In this study, we focused on the relationship between MAP levels and 30-day mortality in patients with sepsis.MethodsThis cohort study included 14,607 sepsis patients out of 38,597 adults admitted to Beth Israel Deaconess Medical Center in Boston between 2001 and 2012, according to the Sepsis 3.0 diagnostic criteria. According to the MAP value of the sepsis patients on the first day of intensive care unit (ICU) admission, they were divided into 5 groups (Q1 ≤67.4 mmHg, Q2 67.4-72.5 mmHg, Q3 72.5-77.6 mmHg, Q4 77.6-84.6 mmHg, Q5 ≥84.6 mmHg). At the same time, the baseline data of vital signs, critical illness score, comorbidities and laboratory examination were collected on the first day of admission to ICU. The 30-day mortality of the 5 groups of patients and the overall sepsis patients were recorded. Multivariate Cox regression analysis and smooth curve fitting were used to assess the independent association between MAP and 30-day mortality.ResultsA total of 14,607 sepsis patients were screened. The mean age of participants was 67.2±16.3 years, approximately 46.9% were women, and the overall 30-day mortality rate was 21.0%. Multivariate Cox regression models and smooth curve fitting revealed a non-linear association between MAP and 30-day mortality. The inflection point occurred at 68.6 mmHg. The left side effect size of each 10-unit change in the exposure factor was [hazard ratio (HR): 0.479, 95% confidence interval (CI): 0.403-0.569, P<0.001]. To the right of the inflection point, the effect size was (HR: 0.996, 95% CI: 0.931-1.065, P<0.9018).ConclusionsOur study demonstrated a non-linear relationship between MAP and 30-day mortality in patients with sepsis. When MAP was less than 68.6 mmHg, it was a strong predictor of the potential risk of sepsis death, which declined by 52.1% for every 10 mmHg growth in MAP.
| S-EPMC9469146 | biostudies-literature
Project description:ObjectiveLung is often implicated in sepsis, resulting in acute respiratory distress syndrome (ARDS). The alveolar-arterial oxygen gradient [D(A-a)O2 ] reflects lung diffusing capacity, which is usually compromised in ARDS. But whether D(A-a)O2 impacts the prognosis of patients with sepsis remains to be explored. Our study aims to investigate the association between D(A-a)O2 and 28-day mortality in patients with sepsis using a large sample, multicenter Medical Information Mart for Intensive Care (MIMIC)-IV database.MethodsWe extracted a data of 35 010 patients with sepsis from the retrospective cohort MIMIC-IV database, by which the independent effects of D(A-a)O2 on 28-day death risk was investigated, with D(A-a)O2 as being the exposure variable and 28-day fatality being the outcome variable. Binary logistic regression and a two-piecewise linear model were employed to explore the relationship between D(A-a)O2 and the 28-day death risk after confounding factors were optimized including demographic indicators, Charlson comorbidity index (CCI), Sequential Organ Failure Assessment (SOFA) score, drug administration, and vital signs.ResultsA total of 18 933 patients were finally included in our analysis. The patients' average age was 66.67 ± 16.01 years, and the mortality at 28 days was 19.23% (3640/18933). Multivariate analysis demonstrated that each 10-mmHg rise of D(A-a)O2 was linked with a 3% increase in the probability of death at 28 days either in the unadjusted model or in adjustment for demographic variables (Odds ratio [OR]: 1.03, 95% CI: 1.02 to 1.03). But, each 10 mmHg increase in D(A-a)O2 was associated with a 3% increase of death (OR: 1.03, 95% CI: 1.023 to 1.033) in the case of adjustment for all covariants. Through smoothed curve fitting and generalized summation models, we found that non-linear relationship existed between D(A-a)O2 and the death at 28-day, which demonstrated that D(A-a)O2 had no any impacts on the prognosis of patients with sepsis when D(A-a)O2 was less than or equal to 300 mmHg, but once D(A-a)O2 exceeded 300 mmHg, however, every 10 mmHg elevation of D(A-a)O2 is accompanied by a 5% increase of the 28-day death (OR: 1.05; 95% CI:1.04 to 1.05, p < 0.0001).ConclusionOur findings suggests that D(A-a)O2 is a valuable indicator for the management of sepsis patient, and it is recommended that D(A-a)O2 be maintained less than 300 mmHg as far as possible during sepsis process.
| S-EPMC10214571 | biostudies-literature
Project description:BackgroundThe kidney is one of the most vulnerable organs in sepsis patients, which mainly manifests as sepsis-associated acute kidney injury (SA-AKI). The case fatality rate of SA-AKI is high, and thus, predicting the risk of SA-AKI-related death is hugely significant. Anion gap (AG) is an important indicator in critical illness patients. The present study aimed to analyze the predictive value of the AG for the short-term prognosis of SA-AKI patients.MethodsSA-AKI patient data from the Medical Information Mart for Intensive Care (MIMIC-IV) database were collected retrospectively. Hospitalized septic patients who meet the inclusion criteria were included in the final analysis. All laboratory test parameters only included the data generated within the first 24 hours after the patient entered the intensive care unit (ICU) and the extreme value. Univariate and multivariate logistic regression analyses were performed to analyze the risk factors related to the death of SA-AKI patients within 28 days during hospitalization in the ICU.ResultsA total of 3,684 SA-AKI patients were included, including 3,305 patients with low AG (<18 mmol/L) and 379 patients with high AG (≥18 mmol/L). Among these patients, 497 cases (13.5%) died during hospitalization, including 376 cases (11.4%) in the low AG group and 121 cases (31.9%) in the high AG group. Multivariate logistic regression analysis showed that elevated AG increased the risk of death in SA-AKI patients within 28 days during hospitalization in the ICU (odds ratio =1.2, 95% confidence interval: 1.2-1.3). Further analysis showed that the risk of death of SA-AKI patients within 28 days during hospitalization in the ICU was increased when AG ≥14 mmol/L. The relationship between AG level and the risk of death of SA-AKI patients during hospitalization was S-shaped.ConclusionsIn clinical practice, AG levels can serve as a valuable predictor of the death risk of SA-AKI patients during hospitalization.
| S-EPMC9843358 | biostudies-literature