Wang et al reported a nomogram for predicting 1-year mortality for a patient with sepsis. This can help to identify a patient who may require more aggressive management and follow-up. The authors are from Dalian Medical University in China.
Patient selection: sepsis (from the MIMIC-III database from Beth Israel Deaconess Medical Center)
Parameters:
(1) gender
(2) serum albumin in g/dL
(3) ethnicity
(4) serum potassium in mmol/L
(5) serum LDH in IU/L
(6) respiratory failure
(7) hemoglobin in g/dL
(8) need for vasopressor support
(9) serum alkaline phosphatase in IU/L
(10) serum total calcium in mg/dL
(11) Elixhauser score, from -20 to 80 (apparently using the modified version of van Walraven et al)
(12) age in years from 17 to 90 years of age
points for serum albumin =
= 39.45 - (4.75 * (albumin))
points for serum potassium =
= (2.6 * (potassium)) + 18.4
points for serum LDH =
= (0.00456 * (LDH)) + 23.6
points for hemoglobin =
= 48.44 - (1.97 * (hemoglobin))
points for serum alkaline phosphatase =
= (0.0272 * (alkaline phosphatase)) + 22
points for serum calcium =
= (5.067 * (calcium)) - 15.2
points for Elixhauser score =
= (0.452 * (score)) + 14.94
points for age =
= (0.5117 * (age)) - 8.55
|
Parameter
|
Finding
|
Points
|
|
gender
|
female
|
25.5
|
|
|
male
|
30.8
|
|
ethnicity
|
Asian
|
25.8
|
|
|
Black
|
33
|
|
|
Hispanic
|
39.9
|
|
|
White
|
40.9
|
|
respiratory failure
|
no
|
25.8
|
|
|
yes
|
33.9
|
|
vasopressor support
|
no
|
26.3
|
|
|
yes
|
38.1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 257.3
• maximum score: 585.2
• The higher the score the greater the 1-year mortality.
value of X =
= (0.06505 * (score)) - 21.37
risk of 1-year mortality =
= 1 / ( 1 + EXP((-1) * X))
Performance:
• The are under the ROC curve was 0.77 in the training and 0.75 in the testing cohorts.
