Abstract
Background:
Inflammation and thrombosis are involved in the development and progression of sepsis. A novel thrombo-inflammatory prognostic score (TIPS), based on both an inflammatory and a thrombus biomarker, was assessed for its ability to predict adverse outcomes of sepsis patients in the emergency department (ED).
Methods:
This was a retrospective cohort study of sepsis patients. TIPS (range: 0–2) was predictive of adverse outcomes. Multivariable logistic regression analyses were performed to investigate the associations between TIPS and 28-day adverse outcomes. The study end points were mortality, mechanical ventilation (MV), consciousness disorder (CD) and admission to the intensive care unit (AICU).
Results:
In total, 821 sepsis patients were enrolled; 173 patients died within the 28-day follow-up period. Procalcitonin and D-dimer values were used to calculate TIPS because they had the best performance in the prediction of 28-day mortality by receiver operating characteristic curves. The 28-day mortality and the incidence of MV, CD and AICU were significantly higher in patients with higher TIPS. Multivariable logistic regression analysis indicated TIPS was an independent predictor of 28-day mortality, MV and AICU. TIPS performed better than other prognostic scores, including quick sequential organ failure assessment, Modified Early Warning Score and Mortality in Emergency Department Sepsis Score for predicting 28-day mortality, and similar to the Acute Physiology and Chronic Health Evaluation II, but inferior to sequential organ failure assessment.
Conclusions:
TIPS is useful for stratifying the risk of adverse clinical outcomes in sepsis patients shortly after admission to the ED.
Author contributions: DL and YZ conceived of the study design, analyzed and interpreted the data, and drafted the manuscript. JY, HY and YX contributed to collecting the data and performing the statistical analysis. LZ and WKKW contributed substantially to interpreting the data and critically revised the manuscript for important intellectual content. ZZ, YR and YC participated in the design of the study, acquired the data and helped to revise the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This work was supported financially by grants from the Health and Family Planning Commission of Sichuan Province (No. 16PJ305), Beijing Union Medical Foundation – Rui E special fund for emergency medical research, and the Chinese Ministry of Health and Family Planning Commission (No. 201302003).
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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