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Hypoalbuminemia, Low Base Excess Values, and Tachypnea Predict 28-Day Mortality in Severe Sepsis and Septic Shock Patients in the Emergency Department

Authors
 Min Ho Seo  ;  Minhong Choa  ;  Je Sung You  ;  Hye Sun Lee  ;  Jung Hwa Hong  ;  Yoo Seok Park  ;  Sung Phil Chung  ;  Incheol Park 
Citation
 YONSEI MEDICAL JOURNAL, Vol.57(6) : 1361-1369, 2016 
Journal Title
YONSEI MEDICAL JOURNAL
ISSN
 0513-5796 
Issue Date
2016
MeSH
Adult ; Aged ; Biomarkers/blood* ; Decision Support Techniques ; Emergency Service, Hospital ; Female ; Humans ; Hypoalbuminemia* ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Retrospective Studies ; Sepsis/diagnosis ; Sepsis/mortality* ; Shock, Septic/diagnosis ; Shock, Septic/mortality* ; Shock, Septic/therapy ; Tachypnea*
Keywords
Severe sepsis ; mortality ; nomograms ; septic shock
Abstract
PURPOSE: 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.

MATERIALS AND 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).

CONCLUSION: 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.
Files in This Item:
T201603516.pdf Download
DOI
10.3349/ymj.2016.57.6.1361
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Park, Yoo Seok(박유석) ORCID logo https://orcid.org/0000-0003-1543-4664
Park, In Cheol(박인철) ORCID logo https://orcid.org/0000-0001-7033-766X
Seo, Min Ho(서민호)
You, Je Sung(유제성) ORCID logo https://orcid.org/0000-0002-2074-6745
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
Choa, Min Hong(좌민홍) ORCID logo https://orcid.org/0000-0003-0338-994X
Hong, Jung Hwa(홍정화)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152017
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