Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach

Objectives:. To determine if a set of time-varying biological indicators can be used to: 1) predict the sepsis mortality risk over time and 2) generate mortality risk profiles. Design:. Prospective observational study. Setting:. Nine Canadian ICUs. Subjects:. Three-hundred fifty-six septic patients....

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Autores principales:	Patricia C. Liaw, PhD, Alison E. Fox-Robichaud, MSc, MD, FRCPC, Kao-Lee Liaw, PhD, Ellen McDonald, RN, Dhruva J. Dwivedi, PhD, Nasim M. Zamir, MD, Laura Pepler, PhD, Travis J. Gould, PhD, Michael Xu, MSc, Nicole Zytaruk, RN, Sarah K. Medeiros, BSc, Lauralyn McIntyre, MD, FRCPC, Jennifer Tsang, MD, PhD, FRCPC, Peter M. Dodek, MD, MHSc, Brent W. Winston, MD, FRCPC, Claudio Martin, MSc, MD, FRCPC, Douglas D. Fraser, MD, PhD, FRCPC, Jeffrey I. Weitz, MD, FRCPC, Francois Lellouche, MD, PhD, Deborah J. Cook, MD, FRCPC, John Marshall, MD, FRCPC, for the Canadian Critical Care Translational Biology Group (CCCTBG) and the Canadian Critical Care Trials Group (CCCTG), Jamie Hutchison, Jane Batt, Emmanuel Charbonney, Jean-Francois Cailhier, Rob Fowler, Paul Hebert, Kusum Menon, Karen Burns, Shane English, John Drover, Bram Rochwerg, Dominique Piquette, Margaret Herridge, Sylvie Debigare, Srinivas Murthy, Michelle Kho, Danae Tassy
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2019
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/322866702a8847a9bc12e98249ff2dbb
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spelling	oai:doaj.org-article:322866702a8847a9bc12e98249ff2dbb2021-11-25T07:50:19ZMortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach2639-802810.1097/CCE.0000000000000032https://doaj.org/article/322866702a8847a9bc12e98249ff2dbb2019-08-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000032https://doaj.org/toc/2639-8028Objectives:. To determine if a set of time-varying biological indicators can be used to: 1) predict the sepsis mortality risk over time and 2) generate mortality risk profiles. Design:. Prospective observational study. Setting:. Nine Canadian ICUs. Subjects:. Three-hundred fifty-six septic patients. Interventions:. None. Measurements and Main Results:. Clinical data and plasma levels of biomarkers were collected longitudinally. We used a complementary log-log model to account for the daily mortality risk of each patient until death in ICU/hospital, discharge, or 28 days after admission. The model, which is a versatile version of the Cox model for gaining longitudinal insights, created a composite indicator (the daily hazard of dying) from the “day 1” and “change” variables of six time-varying biological indicators (cell-free DNA, protein C, platelet count, creatinine, Glasgow Coma Scale score, and lactate) and a set of contextual variables (age, presence of chronic lung disease or previous brain injury, and duration of stay), achieving a high predictive power (conventional area under the curve, 0.90; 95% CI, 0.86–0.94). Including change variables avoided misleading inferences about the effects of day 1 variables, signifying the importance of the longitudinal approach. We then generated mortality risk profiles that highlight the relative contributions among the time-varying biological indicators to overall mortality risk. The tool was validated in 28 nonseptic patients from the same ICUs who became septic later and was subject to 10-fold cross-validation, achieving similarly high area under the curve. Conclusions:. Using a novel version of the Cox model, we created a prognostic tool for septic patients that yields not only a predicted probability of dying but also a mortality risk profile that reveals how six time-varying biological indicators differentially and longitudinally account for the patient’s overall daily mortality risk.Patricia C. Liaw, PhDAlison E. Fox-Robichaud, MSc, MD, FRCPCKao-Lee Liaw, PhDEllen McDonald, RNDhruva J. Dwivedi, PhDNasim M. Zamir, MDLaura Pepler, PhDTravis J. Gould, PhDMichael Xu, MScNicole Zytaruk, RNSarah K. Medeiros, BScLauralyn McIntyre, MD, FRCPCJennifer Tsang, MD, PhD, FRCPCPeter M. Dodek, MD, MHScBrent W. Winston, MD, FRCPCClaudio Martin, MSc, MD, FRCPCDouglas D. Fraser, MD, PhD, FRCPCJeffrey I. Weitz, MD, FRCPCFrancois Lellouche, MD, PhDDeborah J. Cook, MD, FRCPCJohn Marshall, MD, FRCPCfor the Canadian Critical Care Translational Biology Group (CCCTBG) and the Canadian Critical Care Trials Group (CCCTG)Jamie HutchisonJane BattEmmanuel CharbonneyJean-Francois CailhierRob FowlerPaul HebertKusum MenonKaren BurnsShane EnglishJohn DroverBram RochwergDominique PiquetteMargaret HerridgeSylvie DebigareSrinivas MurthyMichelle KhoDanae TassyWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 1, Iss 8, p e0032 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Patricia C. Liaw, PhD Alison E. Fox-Robichaud, MSc, MD, FRCPC Kao-Lee Liaw, PhD Ellen McDonald, RN Dhruva J. Dwivedi, PhD Nasim M. Zamir, MD Laura Pepler, PhD Travis J. Gould, PhD Michael Xu, MSc Nicole Zytaruk, RN Sarah K. Medeiros, BSc Lauralyn McIntyre, MD, FRCPC Jennifer Tsang, MD, PhD, FRCPC Peter M. Dodek, MD, MHSc Brent W. Winston, MD, FRCPC Claudio Martin, MSc, MD, FRCPC Douglas D. Fraser, MD, PhD, FRCPC Jeffrey I. Weitz, MD, FRCPC Francois Lellouche, MD, PhD Deborah J. Cook, MD, FRCPC John Marshall, MD, FRCPC for the Canadian Critical Care Translational Biology Group (CCCTBG) and the Canadian Critical Care Trials Group (CCCTG) Jamie Hutchison Jane Batt Emmanuel Charbonney Jean-Francois Cailhier Rob Fowler Paul Hebert Kusum Menon Karen Burns Shane English John Drover Bram Rochwerg Dominique Piquette Margaret Herridge Sylvie Debigare Srinivas Murthy Michelle Kho Danae Tassy Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach
description	Objectives:. To determine if a set of time-varying biological indicators can be used to: 1) predict the sepsis mortality risk over time and 2) generate mortality risk profiles. Design:. Prospective observational study. Setting:. Nine Canadian ICUs. Subjects:. Three-hundred fifty-six septic patients. Interventions:. None. Measurements and Main Results:. Clinical data and plasma levels of biomarkers were collected longitudinally. We used a complementary log-log model to account for the daily mortality risk of each patient until death in ICU/hospital, discharge, or 28 days after admission. The model, which is a versatile version of the Cox model for gaining longitudinal insights, created a composite indicator (the daily hazard of dying) from the “day 1” and “change” variables of six time-varying biological indicators (cell-free DNA, protein C, platelet count, creatinine, Glasgow Coma Scale score, and lactate) and a set of contextual variables (age, presence of chronic lung disease or previous brain injury, and duration of stay), achieving a high predictive power (conventional area under the curve, 0.90; 95% CI, 0.86–0.94). Including change variables avoided misleading inferences about the effects of day 1 variables, signifying the importance of the longitudinal approach. We then generated mortality risk profiles that highlight the relative contributions among the time-varying biological indicators to overall mortality risk. The tool was validated in 28 nonseptic patients from the same ICUs who became septic later and was subject to 10-fold cross-validation, achieving similarly high area under the curve. Conclusions:. Using a novel version of the Cox model, we created a prognostic tool for septic patients that yields not only a predicted probability of dying but also a mortality risk profile that reveals how six time-varying biological indicators differentially and longitudinally account for the patient’s overall daily mortality risk.
format	article
author	Patricia C. Liaw, PhD Alison E. Fox-Robichaud, MSc, MD, FRCPC Kao-Lee Liaw, PhD Ellen McDonald, RN Dhruva J. Dwivedi, PhD Nasim M. Zamir, MD Laura Pepler, PhD Travis J. Gould, PhD Michael Xu, MSc Nicole Zytaruk, RN Sarah K. Medeiros, BSc Lauralyn McIntyre, MD, FRCPC Jennifer Tsang, MD, PhD, FRCPC Peter M. Dodek, MD, MHSc Brent W. Winston, MD, FRCPC Claudio Martin, MSc, MD, FRCPC Douglas D. Fraser, MD, PhD, FRCPC Jeffrey I. Weitz, MD, FRCPC Francois Lellouche, MD, PhD Deborah J. Cook, MD, FRCPC John Marshall, MD, FRCPC for the Canadian Critical Care Translational Biology Group (CCCTBG) and the Canadian Critical Care Trials Group (CCCTG) Jamie Hutchison Jane Batt Emmanuel Charbonney Jean-Francois Cailhier Rob Fowler Paul Hebert Kusum Menon Karen Burns Shane English John Drover Bram Rochwerg Dominique Piquette Margaret Herridge Sylvie Debigare Srinivas Murthy Michelle Kho Danae Tassy
author_facet	Patricia C. Liaw, PhD Alison E. Fox-Robichaud, MSc, MD, FRCPC Kao-Lee Liaw, PhD Ellen McDonald, RN Dhruva J. Dwivedi, PhD Nasim M. Zamir, MD Laura Pepler, PhD Travis J. Gould, PhD Michael Xu, MSc Nicole Zytaruk, RN Sarah K. Medeiros, BSc Lauralyn McIntyre, MD, FRCPC Jennifer Tsang, MD, PhD, FRCPC Peter M. Dodek, MD, MHSc Brent W. Winston, MD, FRCPC Claudio Martin, MSc, MD, FRCPC Douglas D. Fraser, MD, PhD, FRCPC Jeffrey I. Weitz, MD, FRCPC Francois Lellouche, MD, PhD Deborah J. Cook, MD, FRCPC John Marshall, MD, FRCPC for the Canadian Critical Care Translational Biology Group (CCCTBG) and the Canadian Critical Care Trials Group (CCCTG) Jamie Hutchison Jane Batt Emmanuel Charbonney Jean-Francois Cailhier Rob Fowler Paul Hebert Kusum Menon Karen Burns Shane English John Drover Bram Rochwerg Dominique Piquette Margaret Herridge Sylvie Debigare Srinivas Murthy Michelle Kho Danae Tassy
author_sort	Patricia C. Liaw, PhD
title	Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach
title_short	Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach
title_full	Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach
title_fullStr	Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach
title_full_unstemmed	Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach
title_sort	mortality risk profiles for sepsis: a novel longitudinal and multivariable approach
publisher	Wolters Kluwer
publishDate	2019
url	https://doaj.org/article/322866702a8847a9bc12e98249ff2dbb
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Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach

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