Levy et al identified risk factors for mortality in a patient with septic shock. These can help identify a patient who may require more aggressive management. The authors are from multiple hospitals in France.
Independent predictors of mortality from multivariate analysis:
(1) dopamine resistance (odds ratio 9.5)
(2) arterial lactate > 3.5 mmol/L (odds ratio 1.8)
(3) SOFA (sepsis-related organ failure assessment) score > 10 (odds ratio 1.4)
where:
• Dopamine resistance was defined as a mean arterial pressure (MAP) < 70 mm Hg after an infusion of dopamine 20 micrograms per kilogram per minute.
Performance:
• The sensitivity of dopamine resistance alone is 84% with specificity 74%.
• The sensitivity of both dopamine resistance and elevated lactate is 90% with specificity 92%.
A possible way to use this data:
(1) Assign 1 point to an odds ratio of 1.4 - 1.8.
(2) Assign 6 points to an odds ratio of 9.5.
(3) Create a risk score from 0 to 8.
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