Nomogram to predict a poor outcome in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA)

Objective.

To develop a nomograph to predict a poor outcome (death during hospitalization or a hospital stay longer than 15 days) in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA).

Methods.

Prospective, observational study carried out in a single universitary hospital. All patients admitted from the emergency department with sepsis and SOFA scores of 6 or lower were enrolled. We used bivariate logistic regression analysis to develop a predictive nomogram.

Results.

A total of 174 patients were included. Seventeen patients (9.8%) died during hospitalization and the average hospital stay was greater than 15 days in 29 (16.7%) patient. The outcome was poor in a total of 42 patients (24.1%);.Independent variables that were significantly associated with a poor outcome wereSOFA score (odds ratio [OR], 1.3; 95% CI, 1.06–1.71; P<.05), C-reactive protein (CRP) concentration (OR, 1.04; 95% CI, 1.0–1.09; P<.05), N-terminal fragment of brain natriuretic peptide (NT-proBNP) concentration over 1330 ng/mL (OR, 2.64; 95% CI, 1.17–6.22; P<.05), and septic shock (OR, 8.3; 95% CI, 1.16–166.5; P<.05). For a SOFA score of 2 or more the crude OR was 4.44 (95%, CI, 1.91–10.34) and the OR adjusted for other variables was 3.08 (95% CI, 1.24–7.69).

Conclusions.

A high percentage of patients predicted to be at low risk of organ failure had poor outcomes, associated with SOFA score, the presence of septic shock, CRP concentration, and elevated NT-proBNP concentration. The SOFA score by itself is an inadequate prognostic tool in patients at low risk of organ damage. Other clinical and analytical variables are required to complement the SOFA score.