BackgroundTo develop a mathematical model to estimate daily evolution of disease severity using routinely available parameters in patients admitted to the intensive care unit (ICU).MethodsOver a 3-year period, we prospectively enrolled consecutive adults with sepsis and categorized patients as (1) being at risk for developing (more severe) organ dysfunction, (2) having (potentially still reversible) limited organ failure, or (3) having multiple-organ failure. Daily probabilities for transitions between these disease states, and to death or discharge, during the first 2 weeks in ICU were calculated using a multi-state model that was updated every 2 days using both baseline and time-varying information. The model was validated in independent patients.ResultsWe studied 1371 sepsis admissions in 1251 patients. Upon presentation, 53 (4%) were classed at risk, 1151 (84%) had limited organ failure, and 167 (12%) had multiple-organ failure. Among patients with limited organ failure, 197 (17%) evolved to multiple-organ failure or died and 809 (70%) improved or were discharged alive within 14 days. Among patients with multiple-organ failure, 67 (40%) died and 91 (54%) improved or were discharged. Treatment response could be predicted with reasonable accuracy (c-statistic ranging from 0.55 to 0.81 for individual disease states, and 0.67 overall). Model performance in the validation cohort was similar.ConclusionsThis prediction model that estimates daily evolution of disease severity during sepsis may eventually support clinicians in making better informed treatment decisions and could be used to evaluate prognostic biomarkers or perform in silico modeling of novel sepsis therapies during trial design.Clinical trial registrationClinicalTrials.gov NCT01905033

中文翻译：

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预测脓毒症危重患者的临床轨迹：一项队列研究

背景为了开发一个数学模型，使用入住重症监护病房 (ICU) 的患者的常规可用参数来估计疾病严重程度的日常演变。方法在 3 年期间，我们前瞻性地招募了连续的败血症成人，并将患者分类为 (1)有发生（更严重的）器官功能障碍的风险，（2）有（可能仍然可逆的）有限的器官衰竭，或（3）有多器官衰竭。在ICU的前2周内，这些疾病状态之间的转变以及死亡或出院的每日概率是使用多状态模型计算的，该模型每2天使用基线和时变信息更新一次。该模型在独立患者中得到验证。结果我们研究了 1251 名患者中的 1371 名败血症入院病例。介绍时，53 人 (4%) 被归类为有风险，1151 人 (84%) 患有有限器官衰竭，167 人 (12%) 患有多器官衰竭。在局限性器官衰竭的患者中，197 名 (17%) 演变为多器官衰竭或死亡，809 名 (70%) 在 14 天内好转或出院。在多器官衰竭患者中，67 人（40%）死亡，91 人（54%）好转或出院。可以以合理的准确度预测治疗反应（个体疾病状态的 c 统计量范围为 0.55 至 0.81，总体为 0.67）。验证队列中的模型性能相似。