利用电子病历优化新生儿败血症评分以预测死亡率。
Use of an electronic medical record to optimize a neonatal sepsis score for mortality prediction.
机构信息
Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.
Institute for Informatics, Washington University School of Medicine, St. Louis, MO, 63110, USA.
出版信息
J Perinatol. 2023 Jun;43(6):746-751. doi: 10.1038/s41372-022-01573-5. Epub 2022 Nov 30.
OBJECTIVE
Late-onset sepsis (LOS) is a significant cause of mortality in preterm infants. The neonatal sequential organ failure assessment (nSOFA) provides an objective assessment of sepsis risk but requires manual calculation. We developed an EMR pipeline to automate nSOFA calculation for more granular analysis of score performance and to identify optimal alerting thresholds.
METHODS
Infants born <33 weeks of gestation with LOS were included. A SQL-based pipeline calculated hourly nSOFA scores 48 h before/after sepsis evaluation. Sensitivity analysis identified the optimal timing and threshold of nSOFA for LOS mortality.
RESULTS
Eighty episodes of LOS were identified (67 survivors, 13 non-survivor). Non-survivors had persistently elevated nSOFA scores, markedly increasing 12 h prior to culture. At sepsis evaluation, the AUC for nSOFA >2 was 0.744 (p = 0.0047); thresholds of >3 and >4 produced lower AUCs.
CONCLUSIONS
nSOFA is persistently elevated for infants with LOS mortality compared to survivors with an optimal alert threshold >2.
目的
晚发型败血症（LOS）是早产儿死亡的重要原因。新生儿序贯器官衰竭评估（nSOFA）可对败血症风险进行客观评估，但需要手动计算。我们开发了一个 EMR 管道，以实现 nSOFA 的自动计算，从而更细致地分析评分表现，并确定最佳报警阈值。
方法
纳入胎龄<33 周且患有 LOS 的婴儿。基于 SQL 的管道计算 LOS 评估前/后 48 小时的每小时 nSOFA 评分。敏感性分析确定了 nSOFA 对 LOS 死亡率的最佳时机和阈值。
结果
确定了 80 例 LOS 发作（67 例存活，13 例死亡）。死亡组的 nSOFA 评分持续升高，在培养前 12 小时显著增加。在败血症评估时，nSOFA>2 的 AUC 为 0.744（p=0.0047）；>3 和>4 的阈值产生的 AUC 较低。
结论
与幸存者相比，患有 LOS 死亡的婴儿的 nSOFA 持续升高，最佳报警阈值>2。
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