Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
Int J Immunopathol Pharmacol. 2020 Jan-Dec;34:2058738420936386. doi: 10.1177/2058738420936386.
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.
Calibration and discrimination of the SSS were retrospectively evaluated using data from a single-center sepsis registry.
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).
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.
败血症是指宿主对感染的失调反应导致危及生命的器官功能障碍。死亡率很高，败血症性休克患者超过 50%。败血症严重程度评分（SSS）旨在确定败血症的严重程度并作为预后模型。本研究旨在对 SSS 模型进行外部验证。
使用单中心败血症登记处的数据，回顾性评估 SSS 的校准和区分度。
记录了 156 例败血症患者的数据；56%的患者患有败血症性休克，94%的患者需要机械通气。观察到的住院死亡率为 60.3%。平均 SSS 值为 94.4（95%置信区间 90.5-98.3）。SSS 具有出色的区分能力，其接受者操作特征曲线下的面积（AUC）为 0.806（95%置信区间 0.734-0.866）。APACHE II（AUC=0.789；95%置信区间 0.715-0.851）与 SSS 以及第 1 天 SOFA（AUC=0.75；95%置信区间 0.673-0.817）与 SSS 的两两比较显示，模型之间的区分能力无显著差异。SSS 的校准良好，Hosmer-Lemeshow 拟合优度 H 检验为 9.59，P>0.05。校准曲线分析表明，在较低风险（第 2 位和第 4 位）的较低位数上不存在准确的预测。
SSS 表现出出色的区分能力。校准评估结果不一致；H-L 检验结果表明校准良好，而校准曲线的视觉分析则表明相反。在安全推荐 SSS 作为预后预测模型之前，需要进一步评估。
