Derivation and validation of a screening tool for stroke-associated sepsis
Abstract Background Post-stroke infections may cause sepsis, which is associated with poor clinical outcome. Sepsis is defined by life-threatening organ dysfunction that can be identified using the Sequential Organ Failure Assessment (SOFA) score. The applicability of the SOFA score for patients not...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Neurological Research and Practice |
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| Online Access: | https://doi.org/10.1186/s42466-023-00258-4 |
| _version_ | 1797778649556975616 |
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| author | Sebastian Stösser Lisa Kleusch Alina Schenk Matthias Schmid Gabor C. Petzold |
| author_facet | Sebastian Stösser Lisa Kleusch Alina Schenk Matthias Schmid Gabor C. Petzold |
| author_sort | Sebastian Stösser |
| collection | DOAJ |
| description | Abstract Background Post-stroke infections may cause sepsis, which is associated with poor clinical outcome. Sepsis is defined by life-threatening organ dysfunction that can be identified using the Sequential Organ Failure Assessment (SOFA) score. The applicability of the SOFA score for patients not treated on an intensive care unit (ICU) is limited. The aim of this study was to develop and validate an easier-to-use modification of the SOFA score for stroke patients. Methods Using a registry-based cohort of 212 patients with large vessel occlusion stroke and infection, potential predictors of a poor outcome indicating sepsis were assessed by logistic regression. The derived score was validated on a separate cohort of 391 patients with ischemic stroke and infection admitted to our hospital over a period of 1.5 years. Results The derived Stroke-SOFA (S-SOFA) score included the following predictors: National Institutes of Health stroke scale ≥ 14, peripheral oxygen saturation < 90%, mean arterial pressure < 70 mmHg, thrombocyte count < 150 109/l and creatinine ≥ 1.2 mg/dl. The area under the receiver operating curve for the prediction of a poor outcome indicating sepsis was 0.713 [95% confidence interval: 0.665–0.762] for the S-SOFA score, which was comparable to the standard SOFA score (0.750 [0.703–0.798]), but the prespecified criteria for non-inferiority were not met (p = 0.115). However, the S-SOFA score was non-inferior compared to the SOFA score in non-ICU patients (p = 0.013). Conclusions The derived S-SOFA score may be useful to identify non-ICU patients with stroke-associated sepsis who have a high risk of a poor outcome. |
| first_indexed | 2024-03-12T23:19:37Z |
| format | Article |
| id | doaj.art-9cb88d3156094d8ebd81a7af823520bf |
| institution | Directory Open Access Journal |
| issn | 2524-3489 |
| language | English |
| last_indexed | 2024-03-12T23:19:37Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Neurological Research and Practice |
| spelling | doaj.art-9cb88d3156094d8ebd81a7af823520bf2023-07-16T11:32:07ZengBMCNeurological Research and Practice2524-34892023-07-015111010.1186/s42466-023-00258-4Derivation and validation of a screening tool for stroke-associated sepsisSebastian Stösser0Lisa Kleusch1Alina Schenk2Matthias Schmid3Gabor C. Petzold4Division of Vascular Neurology, Department of Neurology, University Hospital BonnDivision of Vascular Neurology, Department of Neurology, University Hospital BonnInstitute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of BonnInstitute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of BonnDivision of Vascular Neurology, Department of Neurology, University Hospital BonnAbstract Background Post-stroke infections may cause sepsis, which is associated with poor clinical outcome. Sepsis is defined by life-threatening organ dysfunction that can be identified using the Sequential Organ Failure Assessment (SOFA) score. The applicability of the SOFA score for patients not treated on an intensive care unit (ICU) is limited. The aim of this study was to develop and validate an easier-to-use modification of the SOFA score for stroke patients. Methods Using a registry-based cohort of 212 patients with large vessel occlusion stroke and infection, potential predictors of a poor outcome indicating sepsis were assessed by logistic regression. The derived score was validated on a separate cohort of 391 patients with ischemic stroke and infection admitted to our hospital over a period of 1.5 years. Results The derived Stroke-SOFA (S-SOFA) score included the following predictors: National Institutes of Health stroke scale ≥ 14, peripheral oxygen saturation < 90%, mean arterial pressure < 70 mmHg, thrombocyte count < 150 109/l and creatinine ≥ 1.2 mg/dl. The area under the receiver operating curve for the prediction of a poor outcome indicating sepsis was 0.713 [95% confidence interval: 0.665–0.762] for the S-SOFA score, which was comparable to the standard SOFA score (0.750 [0.703–0.798]), but the prespecified criteria for non-inferiority were not met (p = 0.115). However, the S-SOFA score was non-inferior compared to the SOFA score in non-ICU patients (p = 0.013). Conclusions The derived S-SOFA score may be useful to identify non-ICU patients with stroke-associated sepsis who have a high risk of a poor outcome.https://doi.org/10.1186/s42466-023-00258-4sepsisIschemic strokePatient outcome assessmentInfectionsOrgan dysfunction scores |
| spellingShingle | Sebastian Stösser Lisa Kleusch Alina Schenk Matthias Schmid Gabor C. Petzold Derivation and validation of a screening tool for stroke-associated sepsis Neurological Research and Practice sepsis Ischemic stroke Patient outcome assessment Infections Organ dysfunction scores |
| title | Derivation and validation of a screening tool for stroke-associated sepsis |
| title_full | Derivation and validation of a screening tool for stroke-associated sepsis |
| title_fullStr | Derivation and validation of a screening tool for stroke-associated sepsis |
| title_full_unstemmed | Derivation and validation of a screening tool for stroke-associated sepsis |
| title_short | Derivation and validation of a screening tool for stroke-associated sepsis |
| title_sort | derivation and validation of a screening tool for stroke associated sepsis |
| topic | sepsis Ischemic stroke Patient outcome assessment Infections Organ dysfunction scores |
| url | https://doi.org/10.1186/s42466-023-00258-4 |
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