Hypoalbuminemia, Low Base Excess Values, and Tachypnea Predict 28-Day Mortality in Severe Sepsis and Septic Shock Patients in the Emergency Department.
OBJECTIVE
The objective of this study was to develop a new nomogram that can predict 28-day mortality in severe sepsis and/or septic shock patients using a combination of several biomarkers that are inexpensive and readily available in most emergency departments, with and without scoring systems.


METHODS
We enrolled 561 patients who were admitted to an emergency department (ED) and received early goal-directed therapy for severe sepsis or septic shock. We collected demographic data, initial vital signs, and laboratory data sampled at the time of ED admission. Patients were randomly assigned to a training set or validation set. For the training set, we generated models using independent variables associated with 28-day mortality by multivariate analysis, and developed a new nomogram for the prediction of 28-day mortality. Thereafter, the diagnostic accuracy of the nomogram was tested using the validation set.


RESULTS
The prediction model that included albumin, base excess, and respiratory rate demonstrated the largest area under the receiver operating characteristic curve (AUC) value of 0.8173 [95% confidence interval (CI), 0.7605-0.8741]. The logistic analysis revealed that a conventional scoring system was not associated with 28-day mortality. In the validation set, the discrimination of a newly developed nomogram was also good, with an AUC value of 0.7537 (95% CI, 0.6563-0.8512).


CONCLUSIONS
Our new nomogram is valuable in predicting the 28-day mortality of patients with severe sepsis and/or septic shock in the emergency department. Moreover, our readily available nomogram is superior to conventional scoring systems in predicting mortality.
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Min Ho
MH
Seo
Institute for Disaster Relief and Medical Safety Net, Yonsei University College of Medicine, Seoul, Korea.
Minhong
M
Choa
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Je Sung
JS
You
Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
Hye Sun
HS
Lee
Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
Jung Hwa
JH
Hong
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. pys905@yuhs.ac.
Yoo Seok
YS
Park
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Sung Phil
SP
Chung
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Incheol
I
Park
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015415:Biomarkers / Q000097:blood; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D034141:Hypoalbuminemia; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D059246:Tachypnea
D015415:Biomarkers
Severe sepsis; mortality; nomograms; septic shock