Factors associated with SIRS negativity at the early stage of sepsis among nonsurviving sepsis patients in ICU: Targeting “silent sepsis”
Notice bibliographique
Résumé
Abstract Background Despite the very high sensitivity of the Systemic Inflammatory Response Syndrome (SIRS) score for identifying sepsis, there remains a subset of septic patients who exhibit negative SIRS scores, and unfortunately, many of these patients experience poor outcomes. This study aims to investigate the factors associated with SIRS negativity during the early stage of sepsis in deceased septic patients. Methods Adult septic patients were included from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database between 2008 and 2019. Sepsis was determined based on the Sepsis 3.0 criteria. Patients who did not survive after 28 days were assigned to the SIRS-negative or SIRS-positive group according to whether the SIRS score was less than two points within 24 hours of intensive care unit (ICU) admission. The baseline data of patients in the SIRS-negative and SIRS-positive groups were collected and compared. The factors associated with SIRS negativity in septic patients were analysed by logistic regression. The dose-response relationships of SIRS negativity with SOFA score and age were determined with a restricted cubic spline model. Results A total of 53,150 patients were screened in the MIMIC-IV database, and 2706 sepsis nonsurvivors were ultimately included, 101 of whom were negative for SIRS. There were significant differences in SOFA scores between groups (8.18 ± 3.58 vs. 9.75 ± 4.28, P < 0.001). In addition, differences in several other parameters nearly reached statistical significance, including age (76 [61 to 86] vs. 72 [60 to 82], P = 0.053), body mass index (BMI) (26 [22 to 31] vs. 27 [24 to 32], P = 0.056), and the Charlson comorbidity index (8 [6 to 9] vs. 7 [5 to 9], P = 0.052). Logistic regression analysis indicated that both SOFA score (OR = 0.93 [95% CI = 0.87-1.00], P = 0.046) and age (OR = 1.04 [95% CI = 0.88–1.15], P = 0.012) were independent factors related to SIRS negativity in septic patients. Analysis with a restricted cubic spline model showed that the odds ratio (OR) of SIRS negativity continued to increase with age, particularly for those over 80 years old (p for nonlinearity = 0.024). The odds ratio of SIRS negativity was more than 1 when the SOFA score was less than 4 (p for nonlinearity = 0.261). Conclusions For sepsis patients with poor prognoses, elderly individuals (over 80 years) are more likely to be SIRS negative when they have mild organ dysfunction damage (less than 4 SOFA scores) in the early stage of sepsis. This warranted an opportunity to provide early diagnosis for elderly population with negative SIRS score, in order to prevent poor outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».