Sepsis has a spectrum of clinical courses, and not all need to be managed in the intensive care unit. Wahab et al identified factors that can help to identify a patient who can be managed in a less intensive care setting. The authors are from the Mayo Clinic.
Patient selection: sepsis
Parameters:
(1) oxygen flow in L/min
(2) serum creatinine in mg/dL
(3) age of the patient in years
(4) body temperature in °C
(5) serum lactate in mmol/L
(6) WBC count per microliter
(7) heart rate in beats per minute
(8) respiratory rate in breaths per minute
|
Parameter
|
Finding
|
Points
|
|
oxygen flow
|
<= 4 L/min
|
0
|
|
|
> 4 L/min
|
1.5
|
|
serum creatinine
|
<= 1.6 mg/dL
|
0
|
|
|
> 1.6 mg/dL
|
1.5
|
|
age
|
<= 65 years
|
0
|
|
|
> 65 years
|
1
|
|
body temperature
|
< 37°C
|
1
|
|
|
>= 37°C
|
0
|
|
serum lactate
|
<= 3 mmol/L
|
0
|
|
|
> 3 mmol/L
|
1
|
|
WBC count
|
<= 15,000 per µL
|
0
|
|
|
> 15,000 per µL
|
1
|
|
heart rate
|
<= 100 beats per minute
|
0
|
|
|
> 100 beats per minute
|
0.5
|
|
respiratory rate
|
<= 25 breaths per minute
|
0
|
|
|
> 25 breaths per minute
|
0.5
|
Interpretation:
• minimum score: 0
• maximum score: 8
• A cutoff score of 3 had an odds ratio of 0.15 for outpatient management (i.e., should be managed in the ICU). This means that a score from 0 to 3 identifies a patient who can be managed outside of the ICU.
• According to Figure 3 the percentages of patients that can be managed outside the ICU was > 95% for score 0, 84% for score 1 and 66% for score 2. Score 3 had a 50:50 chance so would probably be managed in the ICU.
Performance:
• The area under the ROC curve was 0.80.
