Serial Daily Organ Failure Assessment Beyond ICU Day 5 Does Not Independently Add Precision to ICU Risk-of-Death Prediction

• Type of Material: Article
• Authors: Andre Holder, Emory University; Elizabeth Overton, Emory University; Peter Lyu, Harvard University; Jordan Kempker, Emory University; Shamim Nemati, Emory University; Fereshteh Razmi, Emory University; Gregory Martin, Emory University; Timothy Buchman, Emory University; David Murphy, Emory University
• Language: English
• Date: 2017-12-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1097/CCM.0000000000002708
• Title of Journal or Parent Work: Critical Care Medicine
• ISSN: 0090-3493
• Volume: 45
• Issue: 12
• Start Page: 2014
• End Page: 2022
• Grant/Funding Information: Dr. Kempker receives support from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000454 and KL2 TR000455).; Dr. Nemati is supported by the National Institute of Environmental Health Sciences of the NIH (K01 ES025445).; Dr. Holder received support from CR Bard.; Dr. Buchman is an investigator in the Surgical Critical Care Initiative (http://www.SC2i.org), a federally funded activity administered through the Henry M. Jackson Foundation for the Advancement of Military Medicine (http://www.hjf.org). He is also the Editor-in-Chief of Critical Care Medicine.; Dr. Martin received funding from Bard, Grifols (Medical Advisory Boards) and received support for article research from the NIH. His institution received funding from the NIH, Food and Drug Administration (FDA), and Baxter Healthcare. He is supported by the National Institute for General Medical Sciences (R01 GM113228), and the National Center for Advancing Translational Sciences of the NIH (UL1 TR000454).
• Keywords: Science & Technology; INTENSIVE-CARE UNITS; SOFA SCORE; EMERGENCY-DEPARTMENT PATIENTS; SEPSIS; MULTICENTER; Critical Care Medicine; ASSESSMENT SCORE; sepsis; DYSFUNCTION/FAILURE; Life Sciences & Biomedicine; organ failure; General & Internal Medicine; METAANALYSIS; MORTALITY; intensive care unit; prognostication; mortality
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Objectives: To identify circumstances in which repeated measures of organ failure would improve mortality prediction in ICU patients. Design: Retrospective cohort study, with external validation in a deidentified ICU database. Setting: Eleven ICUs in three university hospitals within an academic healthcare system in 2014. Patients: Adults (18 yr old or older) who satisfied the following criteria: 1) two of four systemic inflammatory response syndrome criteria plus an ordered blood culture, all within 24 hours of hospital admission; and 2) ICU admission for at least 2 calendar days, within 72 hours of emergency department presentation. Intervention: None Measurements and Main Results: Data were collected until death, ICU discharge, or the seventh ICU day, whichever came first. The highest Sequential Organ Failure Assessment score from the ICU admission day (ICU day 1) was included in a multivariable model controlling for other covariates. The worst Sequential Organ Failure Assessment scores from the first 7 days after ICU admission were incrementally added and retained if they obtained statistical significance (p < 0.05). The cohort was divided into seven subcohorts to facilitate statistical comparison using the integrated discriminatory index. Of the 1,290 derivation cohort patients, 83 patients (6.4%) died in the ICU, compared with 949 of the 8,441 patients (11.2%) in the validation cohort. Incremental addition of Sequential Organ Failure Assessment data up to ICU day 5 improved the integrated discriminatory index in the validation cohort. Adding ICU day 6 or 7 Sequential Organ Failure Assessment data did not further improve model performance. Conclusions: Serial organ failure data improve prediction of ICU mortality, but a point exists after which further data no longer improve ICU mortality prediction of early sepsis.