Background: Initial phase of sepsis is marked by hyperinflammation, while later phase is related to immunosuppression. Cumulative deaths are more common during late phase. To date there has been no specific study to determine prognostic factors and develop a prediction model to predict mortality in late-phase sepsis. Objective: To discover prognostic factors of mortality in late-phase sepsis patients in intensive care units and to develop a mortality prediction model.
Methods: A retrospective cohort was performed on adult patients with severe sepsis who survived for more than
72 hours in Intensive Care Unit of Cipto Mangunkusumo Hospital, Jakarta during October 2011 to November 2012. Independent predictors were identified using Cox’s proportional hazard. Statistically significant predictors were quantified in a prediction model. Callibration model was evaluated using Hosmer-Lemeshow test, while discrimination ability was assessed by area under the curve of receiver operating curve. Results: A total of 220 subjects were recruited. The 28-day mortality in late-phase severe sepsis was 40%. Statistically significant prognostic factors include the reason of ICU admission (medical HR 2,75; CI95% 1,56-4,84 or emergent surgery HR 1,96; CI95% 0,99-3,90), Charlson’s comorbidity index >2 (HR 2,07; CI95% 1,32-3,23), and MSOFA score >4 (HR 2,84; CI95% 1,54-5,24). Prediction model has good ability in discrimination (AUC 0,844) and calibration (Hosmer-Lemeshow test p=0,674). Based on the model, mortality risk was classified into low risk (score 0, mortality 5,4%), moderate risk (score 1-2,5, mortality 20,6%), and high risk (score >2,5, mortality 73,6%). Conclusion: Medical and emergent surgery as reasons of ICU admission, Charlson’s comorbidity index >2 and MSOFA score >4 are prognostic factors of mortality in late-phase severe sepsis patients in ICU of Cipto Mangunkusumo Hospital. A model was developed to predict and classify risk of mortality. Risk of mortality was classified into low (score 0), moderate (score 1-2.5) and high (score >2.5).
Key words: Prognostic factors, prediction model, mortality, late-phase severe sepsis.