Research

Model for predicting short-term mortality of severe sepsis

Christophe Adrie^1,2 , Adrien Francais³ , Antonio Alvarez-Gonzalez¹ , Roman Mounier⁴ , Elie Azoulay⁵ , Jean-Ralph Zahar⁶ , Christophe Clec'h⁷ , Dany Goldgran-Toledano⁸ , Laure Hammer⁹ , Adrien Descorps-Declere¹⁰ , Samir Jamali¹¹ and Jean-Francois Timsit^3,9 for the Outcomerea Study Group

¹Medical-Surgical Intensive Care Unit, Delafontaine Hospital, 2 rue du Dr Lamaze, 93205 Saint Denis, France

²Department of Physiology, Cochin Hospital, Paris Descartes University, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, France

³INSERM U823, Epidemiology of Cancer and Severe Illnesses, Albert Bonniot Institute, BP 217, 38043 Grenoble, France

⁴Medical Intensive Care Unit, Hôpital Louis Mourier, 178, rue des Renouillers, 92701 Colombes, France

⁵Medical Intensive Care Unit, Saint Louis Teaching Hospital, 1 rue Claude Vellefaux, 75011 Paris, France

⁶Department of Microbiology, Necker Teaching Hospital, 149, rue de Sèvres, 75743 Paris Cedex 15, France

⁷Medical-Surgical Intensive Care Unit, Avicenne Teaching Hospital, 125, rue de Stalingrad, 93009 Bobigny Cedex, France

⁸Medical-Surgical Intensive Care Unit, Gonesse Hospital, 25 rue Pierre de Theilley, BP 30071, 95503 Gonesse, France

⁹Medical Intensive Care Unit, Albert Michallon Teaching Hospital, Joseph Fournier University, BP 217, 38043 Grenoble cedex 09, France

¹⁰Surgical Intensive Care Unit, Antoine Béclère Teaching Hospital, 157, rue de la Porte de Trivaux, 92141 Clamart Cedex, France

¹¹Medical-Surgical Intensive Care Unit, Dourdan Hospital, 2, rue du Potelet B.P. 102, 91415 Dourdan Cedex, France

author email corresponding author email

Critical Care 2009, 13:R72doi:10.1186/cc7881

Published:	19 May 2009

Abstract

Introduction

To establish a prognostic model for predicting 14-day mortality in ICU patients with severe sepsis overall and according to place of infection acquisition and to sepsis episode number.

Methods

In this prospective multicentre observational study on a multicentre database (OUTCOMEREA) including data from 12 ICUs, 2268 patients with 2737 episodes of severe sepsis were randomly divided into a training cohort (n = 1458) and a validation cohort (n = 810). Up to four consecutive severe sepsis episodes per patient occurring within the first 28 ICU days were included. We developed a prognostic model for predicting death within 14 days after each episode, based on patient data available at sepsis onset.

Results

Independent predictors of death were logistic organ dysfunction (odds ratio (OR), 1.22 per point, P < 10^-4), septic shock (OR, 1.40; P = 0.01), rank of severe sepsis episode (1 reference, 2: OR, 1.26; P = 0.10 ≥ 3: OR, 2.64; P < 10^-3), multiple sources of infection (OR; 1.45, P = 0.03), simplified acute physiology score II (OR, 1.02 per point; P < 10^-4), McCabe score ([greater than or equal to]2) (OR, 1.96; P < 10^-4), and number of chronic co-morbidities (1: OR, 1.75; P < 10^-3, ≥ 2: OR, 2.24, P < 10^-3). Validity of the model was good in whole cohorts (AUC-ROC, 0.76; 95%CI, 0.74 to 0.79; and HL Chi-square: 15.3 (P = 0.06) for all episodes pooled).

Conclusions

In ICU patients, a prognostic model based on a few easily obtained variables is effective in predicting death within 14 days after the first to fourth episode of severe sepsis complicating community-, hospital-, or ICU-acquired infection.