Development and internal validation of simplified predictive scoring (ICU-SEPSA score) for mortality in patients with multidrug resistant infection

Taranee Sirichayanugul; Chansinee Srisawat; Chawin Thummakomut; Abhisit Prawang; Nina S Huynh; Surasak Saokaew; Pochamana Phisalprapa; Sukrit Kanchanasurakit

doi:10.3389/fphar.2022.938028

Development and internal validation of simplified predictive scoring (ICU-SEPSA score) for mortality in patients with multidrug resistant infection

Front Pharmacol. 2022 Aug 26:13:938028. doi: 10.3389/fphar.2022.938028. eCollection 2022.

Authors

Taranee Sirichayanugul¹, Chansinee Srisawat², Chawin Thummakomut³, Abhisit Prawang⁴, Nina S Huynh⁵, Surasak Saokaew^{6

7

8

9

10}, Pochamana Phisalprapa¹¹, Sukrit Kanchanasurakit^{2

7

8

12}

Affiliations

¹ Division of Drug Information, Department of Pharmacy, Phrae Hospital, Phrae, Thailand.
² Division of Clinical Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
³ Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
⁴ College of Pharmacy, Rangsit University, Phathum Thani, Thailand.
⁵ Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, United States.
⁶ Division of Social and Administration Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
⁷ Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
⁸ Unit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
⁹ Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bander Sunway, Malaysia.
¹⁰ Biofunctional Molecule Exploratory Research Group, Biomedicine Research Advancement Centre, School of Pharmacy, Monash University Malaysia, Bander Sunway, Malaysia.
¹¹ Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹² Division of Pharmaceutical Care, Department of Pharmacy, Phrae Hospital, Phrae, Thailand.

Abstract

Background: Mortality from multidrug-resistant (MDR) pathogens is an urgent healthcare crisis worldwide. At present we do not have any simplified screening tools to predict the risk of mortality associated with MDR infections. The aim of this study was to develop a screening tool to predict mortality in patients with multidrug-resistant organisms. Methods: A retrospective cohort study to evaluate mortality risks in patients with MDR infections was conducted at Phrae Hospital. Univariable and multivariable analyses were used to classify possible risk factors. The model performance was internally validated utilizing the mean of three measures of discrimination corrected by the optimism using a 1000-bootstrap procedure. The coefficients were transformed into item scores by dividing each coefficient with the lowest coefficient and then rounding to the most adjacent number. The area under the receiver operating characteristic curve (AuROC) was used to determine the performance of the model. Results: Between 1 October 2018 and 30 September 2020, a total of 504 patients with MDR infections were enrolled. The ICU-SEPSA score composed of eight clinical risk factors: 1) immunocompromised host, 2) chronic obstructive pulmonary disease, 3) urinary tract infection, 4) sepsis, 5) placement of endotracheal tube, 6) pneumonia, 7) septic shock, and 8) use of antibiotics within the past 3 months. The model showed good calibration (Hosmer-Lemeshow χ2 = 19.27; p-value = 0.50) and good discrimination after optimism correction (AuROC 84.6%, 95% confidence interval [Cl]: 81.0%-88.0%). The positive likelihood ratio of low risk (score ≤ 5) and high risk (score ≥ 8) were 2.07 (95% CI: 1.74-2.46) and 12.35 (95% CI: 4.90-31.13), respectively. Conclusion: A simplified predictive scoring tool wad developed to predict mortality in patients with MDR infections. Due to a single-study design of this study, external validation of the results before applying in other clinical practice settings is warranted.

Keywords: antibiotic resistant; mortality; multidrug-resistant infection; predictive scoring; screening tool.