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Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study

 Youn-Jung Kim  ;  Jihoon Kang  ;  Min-Ju Kim  ;  Seung Mok Ryoo  ;  Gu Hyun Kang  ;  Tae Gun Shin  ;  Yoo Seok Park  ;  Sung-Hyuk Choi  ;  Woon Yong Kwon  ;  Sung Phil Chung  ;  Won Young Kim 
 BMC MEDICINE, Vol.18(1) : 390, 2020-12 
Journal Title
Issue Date
Aged ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms / complications* ; Prognosis ; Prospective Studies ; Reproducibility of Results ; Risk Factors ; Shock, Septic / etiology* ; Shock, Septic / mortality
Critical care ; Neoplasms ; Prognosis ; Sepsis ; Septic shock
Background: Clinical decision-making of invasive high-intensity care for critically ill stage IV cancer patients in the emergency department (ED) is challenging. A reliable and clinically available prognostic score for advanced cancer patients with septic shock presented at ED is essential to improve the quality of intensive care unit care. This study aimed to develop a new prognostic score for advanced solid cancer patients with septic shock available early in the ED and to compare the performance to the previous severity scores. Methods: This multi-center, prospective cohort study included consecutive adult septic shock patients with stage IV solid cancer. A new scoring system for 28-day mortality was developed and validated using the data of development (January 2016 to December 2017; n = 469) and validation sets (January 2018 to June 2019; n = 428). The developed score's performance was compared to that of the previous severity scores. Results: New scoring system for 28-day mortality was based on six variables (score range, 0-8): vital signs at ED presentation (respiratory rate, body temperature, and altered mentation), lung cancer type, and two laboratory values (lactate and albumin) in septic shock (VitaL CLASS). The C-statistic of the VitaL CLASS score was 0.808 in the development set and 0.736 in the validation set, that is superior to that of the Sequential Organ Failure Assessment score (0.656, p = 0.01) and similar to that of the Acute Physiology and Chronic Health Evaluation II score (0.682, p = 0.08). This score could identify 41% of patients with a low-risk group (observed 28-day mortality, 10.3%) and 7% of patients with a high-risk group (observed 28-day mortality, 73.3%). Conclusions: The VitaL CLASS score could be used for both risk stratification and as part of a shared clinical decision-making strategy for stage IV solid cancer patients with septic shock admitting at ED within several hours.
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1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
Yonsei Authors
Park, Yoo Seok(박유석) ORCID logo https://orcid.org/0000-0003-1543-4664
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
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