Aranza Ivan, Vuković Miro, Biloš Valentina, Juginović Alen
Department of Cardiology, University Hospital Split, Spinčićeva 1, Split, 21000, Croatia.
Center for Evidence-Based Medicine, University of Split School of Medicine, Šoltanska 2A, Split, 21000, Croatia.
BMC Infect Dis. 2025 Jul 1;25(1):876. doi: 10.1186/s12879-025-10920-8.
Sepsis is a complex life-threatening condition. Early initiation of treatment is crucial in reducing mortality. Current scoring systems have a lack of reliability in the emergency department (ED) or during early hospitalization (EH). Thus, a quick, reliable, and objective scoring system for assessing mortality risk during EH or ED could significantly reduce sepsis mortality.
Using the MIMIC-IV database, we identified 7546 patients hospitalized due to septicemia. We included 13 comorbidity groups and the first chronologically available values of 75 laboratory parameters from the ED or EH. To create and validate our scoring system for early prediction of in-hospital mortality (e-SEPSS), patients were assigned to model development (MD) (N = 1004) or model validation (MV) group (N = 6542), with the latter serving as internal validation of e-SEPSS. Each risk factor that contributed significantly to mortality was assigned one point. Groups with different numbers of points were compared according to mortality and hospitalization duration.
Decreased chlorides, increased mean corpuscular hemoglobin, increased red blood cell distribution width, increased phosphates, decreased pH, increased partial thromboplastin time, and increased lactate dehydrogenase were included in e-SEPSS due to the highest reliability in predicting mortality. Patients received 1 point for each parameter, creating 8 mortality risk groups. A significant linear increase in mortality with each additional point was shown, ranging from 4.1% (0 points) to 100% (7 points) in the MD group. Similar trends were observed in the MV group. High power in discriminating patients with different mortality risks was shown (MD (ROC AUC = 0.718, CI 0.682-0.754), MV (ROC AUC = 0.798, CI 0.783-0.813)). Decreased survival time and shorter time-to-death with each additional point strengthened the validity of e-SEPSS (Mantel-Cox χ(7) = 994.2, p-value < 0.001).
e-SEPSS provides a simple, objective, reliable, and accessible way of predicting mortality in septic patients in the ED or during EH.. After external and clinical validation of e-SEPSS, it could become a useful additional tool in reducing sepsis mortality.
脓毒症是一种复杂的危及生命的病症。尽早开始治疗对于降低死亡率至关重要。目前的评分系统在急诊科（ED）或早期住院治疗（EH）期间缺乏可靠性。因此，一种用于评估EH或ED期间死亡风险的快速、可靠且客观的评分系统可显著降低脓毒症死亡率。
利用多中心重症医学信息数据库-Ⅳ（MIMIC-IV），我们确定了7546例因败血症住院的患者。我们纳入了13个合并症组以及来自ED或EH的75项实验室参数按时间顺序最早可得的值。为了创建和验证我们用于早期预测住院死亡率的评分系统（e-SEPSS），患者被分配到模型开发（MD）组（N = 1004）或模型验证（MV）组（N = 6542），后者用作e-SEPSS的内部验证。对死亡率有显著贡献的每个风险因素给予1分。根据死亡率和住院时间比较不同分数组。
由于在预测死亡率方面具有最高的可靠性，氯化物降低、平均红细胞血红蛋白增加、红细胞分布宽度增加、磷酸盐增加、pH降低、部分凝血活酶时间增加和乳酸脱氢酶增加被纳入e-SEPSS。每个参数给予患者1分，形成8个死亡风险组。MD组显示随着每增加1分死亡率呈显著线性增加，范围从4.1%（0分）到100%（7分）。MV组也观察到类似趋势。显示出在区分不同死亡风险患者方面具有高辨别力（MD（ROC曲线下面积 = 0.718，CI 0.682 - 0.754），MV（ROC曲线下面积 = 0.798，CI 0.783 - 0.813））。随着每增加1分生存时间缩短和死亡时间缩短加强了e-SEPSS的有效性（Mantel-Cox χ(7)=994.2，p值 < 0.001）。
e-SEPSS提供了一种简单、客观、可靠且可获取的方法来预测ED或EH期间脓毒症患者的死亡率。在对e-SEPSS进行外部和临床验证后，它可能成为降低脓毒症死亡率的一种有用的辅助工具。
