The Impact of Common Variations in Sequential Organ Failure Assessment Score Calculation on Sepsis Measurement Using Sepsis-3 Criteria: A Retrospective Analysis Using Electronic Health Record Data

Alrawashdeh, M; Klompas, M; Rhee, C

doi:10.1097/ccm.0000000000006338

Sepsis & infection

The Impact of Common Variations in Sequential Organ Failure Assessment Score Calculation on Sepsis Measurement Using Sepsis-3 Criteria: A Retrospective Analysis Using Electronic Health Record Data

Crit Care MedPublished 23 May 2024Retrospective cohort study

Main finding · Sepsis incidence, mortality, agreement and predictive validity for mortalityResultKappa 0.99

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Authors' conclusion

Common variations in calculating respiratory and baseline SOFA scores, but not in handling missing data, lead to substantial differences in observed incidence, mortality, agreement, and predictive validity of Sepsis-3 criteria.

Study context

Population: Hospitalized adults, five Massachusetts hospitals, 2015 to 2022
Participants: 1,064,459 hospitalizations

Exposure: Different missing data imputation strategies vs Reference Sequential Organ Failure Assessment (SOFA)
Outcome: Incidence, outcomes, agreement and predictive validity of Sepsis-3 criteria (suspected infection with SOFA increase ≥2 points)

Methodological detailsmulticentre, electronic health record data

Multicentre
Electronic health record data

Main finding

As reported in the abstract

Sepsis incidence, mortality, agreement and predictive validity for mortality

Kappa

0.99

Events by group

Reference SOFA13.3%141,052 events

Sp o2 /F io2 imputations18.3%

Comorbidities and historical laboratory data6.9%

Observational data: associations, not effects.

Further findings

Outcome	Reference SOFA
Community-onset sepsis (subgroup)	11.6%
Mortality	9.6%
AUROC	0.75

Community-onset sepsis (subgroup): Comorbidity/prehospital baseline 6.9% · mortality 13.4% · AUROC 0.79

Suspected infection

Hospitalizations with suspected infection: 297,512 (27.9%)

Missing SOFA components ≥1 day in infection window

PaO2/FiO2 ratios: 98.6%
SpO2/FiO2 ratios: 73.5%
Bilirubin: 68.5%
GCS: 57.2%

Reference

Authors: Alrawashdeh M, Klompas M, Rhee C
Journal: Critical Care Medicine
Published: 23 May 2024
DOI: 10.1097/ccm.0000000000006338
PubMed: 38780372

Topic: Sepsis & infection

Exposure

Variations in SOFA score calculation vs reference SOFA implementation for Sepsis-3

Exposure definitions

Reference SOFA: imputed normal values for missing data, used Pa o2 /F io2 ratios for respiratory scores, and assumed normal baseline SOFA scores for community-onset sepsis
Different missing data imputation strategies: averaging worst values from preceding and following days vs. carrying forward nonmissing values
Sp o2 /F io2 imputations: imputing respiratory scores using Sp o2 /F io2 ratios
Comorbidities and historical laboratory data: incorporating comorbidities and prehospital laboratory data into baseline SOFA scores (community-onset sepsis)

Key notes

Near-perfect agreement in identifying sepsis
Sp o2 /F io2 vs reference AUROC 0.76 vs. 0.78

More notes

Community-onset sepsis: reference incidence 11.6%, mortality 9.6%, AUROC 0.75

Original publication

The Impact of Common Variations in Sequential Organ Failure Assessment Score Calculation on Sepsis Measurement Using Sepsis-3 Criteria: A Retrospective Analysis Using Electronic Health Record Data. Crit Care Med. Published 23 May 2024. doi:10.1097/ccm.0000000000006338

Read the original article ↗

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