The dynamics of disease progression in sepsis: Markov modeling describing the natural history and the likely impact of effective antisepsis agents.
We conducted a 9-month prospective cohort study of 2,527 patients with systemic inflammatory response syndrome in three intensive care units and three general wards in a tertiary health care institution. Markov models were developed to predict the probability of movement to and from more severe stages--sepsis, severe sepsis, or septic shock--at 1, 3, and 7 days. For patients with sepsis, severe sepsis, and septic shock, the probabilities of remaining in the same category after 1 day were .65, .68, and .61, respectively. The probability for progression after 1 day was .09 for sepsis to severe sepsis and .026 for severe sepsis to shock. The probability of patients with sepsis, severe sepsis, and septic shock dying after 1 day was .005, .009, and .079, respectively. The model can be used to predict the reduction in end organ dysfunction and mortality with use of increasingly effective antisepsis agents.
Rangel-Frausto
M S
MS
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.
Pittet
D
D
Hwang
T
T
Woolson
R F
RF
Wenzel
R P
RP
D018450:Disease Progression; D006801:Humans; D007362:Intensive Care Units; D008390:Markov Chains; D011336:Probability; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology