Sequential Organ Failure Assessment Score Modified for Recent Infection in Patients With Hematologic Malignant Tumors and Severe Sepsis

Greenberg, Jared A.; David, Michael Z.; Churpek, Matthew M.; Pitrak, David L.; Hall, Jesse B.; Kress, John P.

doi:10.4037/ajcc2016281

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Critical Care Evaluation| September 01 2016

Sequential Organ Failure Assessment Score Modified for Recent Infection in Patients With Hematologic Malignant Tumors and Severe Sepsis

Jared A. Greenberg, MD, MSc;

Jared A. Greenberg, MD, MSc

Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago.

Corresponding author: Jared A. Greenberg, md, 1725 W Harrison St, Suite 054, Chicago, IL 60612 (e-mail: Jared_greenberg@rush.edu).

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Michael Z. David, MD, PhD;

Michael Z. David, MD, PhD

Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago.

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Matthew M. Churpek, MD, MPH, PhD;

Matthew M. Churpek, MD, MPH, PhD

Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago.

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David L. Pitrak, MD;

David L. Pitrak, MD

Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago.

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Jesse B. Hall, MD;

Jesse B. Hall, MD

Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago.

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John P. Kress, MD

Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago.

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Am J Crit Care (2016) 25 (5): 409–417.

https://doi.org/10.4037/ajcc2016281

Background

Baseline health status influences outcomes of severe sepsis.

Objective

To determine if recent infection is a marker of poor health in patients with hematologic malignant tumors and severe sepsis by modifying the Sequential Organ Failure Assessment (SOFA) score to account for infection.

Methods

Medical records of the first 50 patients with hematologic malignant tumors and severe sepsis admitted from September 1, 2009 to September 1, 2014, were reviewed to derive a modified SOFA score. The predictive accuracy of the modified score was compared with that of the unmodified score and the Acute Physiology and Chronic Health Evaluation (APACHE) II score for the 196 subsequent patients.

Results

The area under the receiver operator characteristic curve was 0.73 (95% CI, 0.66–0.80) for the modified score, 0.68 (95% CI, 0.61–0.76) for the unmodified score, and 0.65 (95% CI, 0.58–0.73) for the APACHE II score. The modified score was better for discriminating survivors from nonsurvivors than the unmodified score (P = .005) and the APACHE II score (P = .04). After adjustments for the modified score and age, only increased days from hospital to intensive care unit admission was significantly associated with 30-day mortality.

Conclusion

Modifying the SOFA score to account for infections before admission to the intensive care unit improved the prognostic usefulness of the scores for patients with hematologic malignant tumors and severe sepsis.

2016

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