Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study
Abstract Background Clinical decision-making of invasive high-intensity care for critically ill stage IV cancer patients in the emergency department (ED) is challenging. A reliable and clinically available prognostic score for advanced cancer patients with septic shock presented at ED is essential t...
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | BMC Medicine |
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| Online Access: | https://doi.org/10.1186/s12916-020-01875-5 |
| _version_ | 1818647403449810944 |
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| author | Youn-Jung Kim Jihoon Kang Min-Ju Kim Seung Mok Ryoo Gu Hyun Kang Tae Gun Shin Yoo Seok Park Sung-Hyuk Choi Woon Yong Kwon Sung Phil Chung Won Young Kim on behalf of the Korean Shock Society (KoSS) Investigators |
| author_facet | Youn-Jung Kim Jihoon Kang Min-Ju Kim Seung Mok Ryoo Gu Hyun Kang Tae Gun Shin Yoo Seok Park Sung-Hyuk Choi Woon Yong Kwon Sung Phil Chung Won Young Kim on behalf of the Korean Shock Society (KoSS) Investigators |
| author_sort | Youn-Jung Kim |
| collection | DOAJ |
| description | Abstract Background Clinical decision-making of invasive high-intensity care for critically ill stage IV cancer patients in the emergency department (ED) is challenging. A reliable and clinically available prognostic score for advanced cancer patients with septic shock presented at ED is essential to improve the quality of intensive care unit care. This study aimed to develop a new prognostic score for advanced solid cancer patients with septic shock available early in the ED and to compare the performance to the previous severity scores. Methods This multi-center, prospective cohort study included consecutive adult septic shock patients with stage IV solid cancer. A new scoring system for 28-day mortality was developed and validated using the data of development (January 2016 to December 2017; n = 469) and validation sets (January 2018 to June 2019; n = 428). The developed score’s performance was compared to that of the previous severity scores. Results New scoring system for 28-day mortality was based on six variables (score range, 0–8): vital signs at ED presentation (respiratory rate, body temperature, and altered mentation), lung cancer type, and two laboratory values (lactate and albumin) in septic shock (VitaL CLASS). The C-statistic of the VitaL CLASS score was 0.808 in the development set and 0.736 in the validation set, that is superior to that of the Sequential Organ Failure Assessment score (0.656, p = 0.01) and similar to that of the Acute Physiology and Chronic Health Evaluation II score (0.682, p = 0.08). This score could identify 41% of patients with a low-risk group (observed 28-day mortality, 10.3%) and 7% of patients with a high-risk group (observed 28-day mortality, 73.3%). Conclusions The VitaL CLASS score could be used for both risk stratification and as part of a shared clinical decision-making strategy for stage IV solid cancer patients with septic shock admitting at ED within several hours. |
| first_indexed | 2024-12-17T01:01:59Z |
| format | Article |
| id | doaj.art-f81352bd6b354b86ae0b979c22658506 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-17T01:01:59Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
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| series | BMC Medicine |
| spelling | doaj.art-f81352bd6b354b86ae0b979c226585062022-12-21T22:09:24ZengBMCBMC Medicine1741-70152020-12-0118111210.1186/s12916-020-01875-5Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort studyYoun-Jung Kim0Jihoon Kang1Min-Ju Kim2Seung Mok Ryoo3Gu Hyun Kang4Tae Gun Shin5Yoo Seok Park6Sung-Hyuk Choi7Woon Yong Kwon8Sung Phil Chung9Won Young Kim10on behalf of the Korean Shock Society (KoSS) InvestigatorsDepartment of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical CenterDepartment of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Clinical Epidemiology and Biostatistics, Asan Medical CenterDepartment of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical CenterDepartment of Emergency Medicine, Hallym University College of MedicineDepartment of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Emergency Medicine, Yonsei University College of MedicineDepartment of Emergency Medicine, Guro Hospital, Korea University Medical CenterDepartment of Emergency Medicine, Seoul National University College of MedicineDepartment of Emergency Medicine, Yonsei University College of MedicineDepartment of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical CenterAbstract Background Clinical decision-making of invasive high-intensity care for critically ill stage IV cancer patients in the emergency department (ED) is challenging. A reliable and clinically available prognostic score for advanced cancer patients with septic shock presented at ED is essential to improve the quality of intensive care unit care. This study aimed to develop a new prognostic score for advanced solid cancer patients with septic shock available early in the ED and to compare the performance to the previous severity scores. Methods This multi-center, prospective cohort study included consecutive adult septic shock patients with stage IV solid cancer. A new scoring system for 28-day mortality was developed and validated using the data of development (January 2016 to December 2017; n = 469) and validation sets (January 2018 to June 2019; n = 428). The developed score’s performance was compared to that of the previous severity scores. Results New scoring system for 28-day mortality was based on six variables (score range, 0–8): vital signs at ED presentation (respiratory rate, body temperature, and altered mentation), lung cancer type, and two laboratory values (lactate and albumin) in septic shock (VitaL CLASS). The C-statistic of the VitaL CLASS score was 0.808 in the development set and 0.736 in the validation set, that is superior to that of the Sequential Organ Failure Assessment score (0.656, p = 0.01) and similar to that of the Acute Physiology and Chronic Health Evaluation II score (0.682, p = 0.08). This score could identify 41% of patients with a low-risk group (observed 28-day mortality, 10.3%) and 7% of patients with a high-risk group (observed 28-day mortality, 73.3%). Conclusions The VitaL CLASS score could be used for both risk stratification and as part of a shared clinical decision-making strategy for stage IV solid cancer patients with septic shock admitting at ED within several hours.https://doi.org/10.1186/s12916-020-01875-5Septic shockSepsisNeoplasmsPrognosisCritical care |
| spellingShingle | Youn-Jung Kim Jihoon Kang Min-Ju Kim Seung Mok Ryoo Gu Hyun Kang Tae Gun Shin Yoo Seok Park Sung-Hyuk Choi Woon Yong Kwon Sung Phil Chung Won Young Kim on behalf of the Korean Shock Society (KoSS) Investigators Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study BMC Medicine Septic shock Sepsis Neoplasms Prognosis Critical care |
| title | Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study |
| title_full | Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study |
| title_fullStr | Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study |
| title_full_unstemmed | Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study |
| title_short | Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study |
| title_sort | development and validation of the vital class score to predict mortality in stage iv solid cancer patients with septic shock in the emergency department a multi center prospective cohort study |
| topic | Septic shock Sepsis Neoplasms Prognosis Critical care |
| url | https://doi.org/10.1186/s12916-020-01875-5 |
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