Sepsis and Septic Shock: Are Initial mSOFA Score, Point-of-Care Lactate, Neutrophil-Lymphocyte Ratio and Platelet Count Good Predictors for Mortality?
Main Article Content
Abstract
Background: Sepsis is a common life threatening medical problem and first leading cause of death in Myanmar. This study was aimed to determine the predictive values of initial mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count for mortality in patients with sepsis and septic shock.
Method: A hospital based prospective observational study done in No.(1) Defence Services General Hospital, Yangon, from January 2021 to October 2022. All patients above 18 years old admitted with sepsis and qSOFA ≥ 2 were enrolled and sample size was 121 patients. The predictors were mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count, which were assessed within 24 hour of admission and the mortality was observed for 28 days. Logistic regression was used to find out the predictive value and the predictors were compared by receiver operating characteristic curve analysis.
Results: The initial mSOFA score, point-of-care lactate and neutrophil-lymphocyte ratio of non survivors were significantly higher than survivors (mSOFA score 9 vs 4), (blood lactate 3.3 mmol/L vs 2 mmol/L), (neutrophil-lymphocyte ratio 13.4 vs 8.3). Platelet count was significantly lower in non-survivors than survivors (175 x 10^9/L vs 290 x 10^9/L). The mortality was 33.1%. The mSOFA score and lactate were strongly correlated (rho = 0.650, p < 0.001). The adjusted odds ratio of mSOFA score was 1.350 (1.135 – 1.606) with adjusted R2 0.478 and accuracy 80.2%. The adjusted odds ratio of lactate was 1.819 (1.168 – 2.834); NLR, 1.108 (1.023 – 1.200); platelet 0.992 (0.987 – 0.998) with adjusted R2 0.616 and accuracy 86.8%. Each predictor had moderate prognostic value (AUC > 0.7) and the combinations of mSOFA score and/or lactate with NLR and platelet count, good prognostic value (AUC > 0.8).
Conclusion: The mSOFA score, lactate, NLR and platelet count had predictive value for mortality assessment in patients with sepsis or septic shock. Lactate level was strongly correlated with disease clinical severity of the sepsis, mSOFA score. The combination of mSOFA score and/or lactate with NLR and platelet count had better predictive value.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet. 2020 Jan;395(10219):200–11.
II. Ministry of Health and Sport. Hospital Statistics Report (2014-16). 2018.
III. Grissom CK, Brown SM, Kuttler KG, Boltax JP, Jones J, Jephson AR, et al. A Modified Sequential Organ Failure Assessment Score for Critical Care Triage. Disaster Med Public Health Prep. 2010 Dec;4(4):277–84.
IV. Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010 Feb 24;303(8):739–46.
V. Ni J, Wang H, Li Y, Shu Y, Liu Y. Neutrophil to lymphocyte ratio (NLR) as a prognostic marker for in-hospital mortality of patients with sepsis: A secondary analysis based on a single-center, retrospective, cohort study. Medicine (Baltimore). 2019 Nov;98(46):e18029.
VI. Terradas R, Grau S, Blanch J, Riu M, Saballs P, Castells X, et al. Eosinophil Count and Neutrophil-Lymphocyte Count Ratio as Prognostic Markers in Patients with Bacteremia: A Retrospective Cohort Study. Caylà JA, editor. PLoS ONE. 2012 Aug 9;7(8):e42860.
VII. Yan J, Li S, Li S. The Role of the Liver in Sepsis. Int Rev Immunol. 2014 Nov 2;33(6):498–510.
VIII. Foreman MG, Mannino DM, Moss M. Cirrhosis as a Risk Factor for Sepsis and Death. Chest. 2003 Sep;124(3):1016–20.
IX. Wong F. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut. 2005 May 1;54(5):718–25.
X. Fuchs PA, Czech IJ, Krzych ŁJ. Mortality Prediction Using SOFA Score in Critically Ill Surgical and Non-Surgical Patients: Which Parameter Is the Most Valuable? Medicina (Mex). 2020 Jun 4;56(6):273.
XI. Li Y, Wang J, Wei B, Zhang X, Hu L, Ye X. Value of Neutrophil:Lymphocyte Ratio Combined with Sequential Organ Failure Assessment Score in Assessing the Prognosis of Sepsis Patients. Int J Gen Med. 2022 Feb;Volume 15:1901–8.
XII. Sipahioglu H, Bahcebası S. The Impact of Sequential Organ Failure Assessment (SOFA) Score on Mortality in Geriatric Patients With Sepsis and Septic Shock in the ICU. Cureus. 2022 Oct;14(10):e30887.
XIII. Villar J, Short JH, Lighthall G. Lactate Predicts Both Short- and Long-Term Mortality in Patients With and Without Sepsis. Infect Dis Res Treat. 2019 Jan;12:117863371986277.
XIV. Charoentanyarak S, Sawunyavisuth B, Deepai S, Sawanyawisuth K. A Point-of-Care Serum Lactate Level and Mortality in Adult Sepsis Patients: A Community Hospital Setting. J Prim Care Community Health. 2021
Jan;12:215013272110002.
XV. Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Patients with Sepsis: A Prospective Observational Study. Mediators Inflamm. 2016;2016:1–8.
XVI. Gameiro J, Fonseca JA, Jorge S, Gouveia J, Lopes JA. Neutrophil, lymphocyte and platelet ratio as a predictor of mortality in septic-acute kidney injury patients. Nefrología. 2020 Jul;40(4):461–8.
XVII. Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F, et al. Diagnostic and prognostic role of platelets in patients with sepsis and septic shock. Platelets. 2023 Dec 31;34(1):2131753.
XVIII. Al Saleh K, AlQahtani RM. Platelet count patterns and patient outcomes in sepsis at a tertiary care center: Beyond the APACHE score. Medicine (Baltimore). 2021 May 7;100(18):e25013.