Abstract
Background
Both the thrombo-inflammatory prognostic score (TIPS) and the quick sequential (sepsis-related) organ failure assessment (qSOFA) are quick prognostic scores for sepsis during the early phase, while either of two scores has limited prognostic value for sepsis patients. This study aimed to evaluate whether TIPS adds more information of sepsis risk stratification for qSOFA.
Methods
This was a retrospective cohort study of patients with sepsis in the emergency department (ED). We performed a receiver-operating characteristic curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision-curve analysis (DCA) analyses to investigate whether TIPS can improve qSOFA for risk prediction in patients with sepsis. The primary endpoint was mortality and the secondary endpoints were mechanical ventilation and admission to the intensive care unit (ICU) during the 28-day follow-up.
Results
We identified 821 patients with sepsis. We randomly assigned the patients’ data to a derivation group (n = 498; n = 112 died during the 28-days follow-up) or to a validation group (n = 323; n = 61). The addition of TIPS to qSOFA (T-qSOFA) improved the area under the curve (AUC) from 0.724 to 0.824 (p < 0.001) for predicting 28-day mortality. The discrimination improvement was confirmed by an IDI of 0.092 (p < 0.001). Addition of TIPS to the qSOFA resulted in a NRI of 0.247 (p < 0.001). The DCA showed that the net benefit of T-qSOFA was higher than that of TIPS or qSOFA for any threshold probabilities.
Conclusions
The prognostic value of qSOFA for patients with sepsis was enhanced by adding the TIPS score on admission for risk prediction in patients with sepsis during early phases in the ED.
Author contributions: DL, SX and YJ conceived of the study design, analysed and interpreted the data, and drafted the manuscript. DL, JY, YC, YJ, YL, and YM contributed to collecting the data and performing the statistical analysis. BL, YX and QZ contributed substantially to interpreting the data and critically revised the manuscript for important intellectual content. RY and ZZ participated in the design of the study, acquired the data, and helped to revise the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This work was supported financially by grants from the Science Foundation of Science and Technology Department of Chengdu (Grant No. 2016-HM02-00099-SF) and Sichuan (Grant Nos. 2018RZ0139 and 2019JDRC0105), and 1•3•5 Project for Disciplines of Excellence-Clinical Research Incubation Project, Sichuan University West China Hospital (Grant Nos. 2018HXFH001 and 2018HXFH027).
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Availability of data and materials: The datasets generated and analysed during the present study are available from the corresponding author on reasonable request.
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2019-0864).
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