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Reassessing the value of short-term mortality in sepsis: Comparing conventional approaches to modeling

Clermont, G and Angus, DC and Kalassian, KG and Linde-Zwirble, WT and Ramakrishnan, N and Linden, PK and Pinsky, MR (2003) Reassessing the value of short-term mortality in sepsis: Comparing conventional approaches to modeling. Critical Care Medicine, 31 (11). 2627 - 2633. ISSN 0090-3493

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Abstract

Objective: Clinical trials of therapies for sepsis have been mostly unsuccessful in impacting mortality. This may be partly due to the use of insensitive mortality end points. We explored whether modeling survival was more sensitive than traditional end points in detecting mortality differences in cohorts of patients with sepsis. Design: Patients were stratified into seven a priori defined paired subgroups that reflected high and low mortality risk according to known clinical risk factors. We fitted an exponential survival model to the high- and low-risk cohort of each subgroup, providing estimates of the rate of dying, long-term survival, and excess day 1 mortality. Mortality in the high- and low-risk cohorts in each subgroup was compared using model parameters, fixed-point mortality, and Kaplan-Meier survival analysis. Setting: Eight intensive care units within a university teaching institution. Patients: One hundred thirty patients with severe sepsis or suspected Gram-negative bacteremia. Interventions: None. Measurements and Main Results: Overall mortality of the cohort was 58.5% at 28 days. The survival of the entire cohort was well described by an exponential model (r2 = .99). Modeling identified differences in high- and low-risk cohorts in five of the seven paired subgroups, while conventional end-points only detected differences in 2. Conclusions: Modeling survival was more sensitive than conventional end-points in identifying survival differences between high- and low-risk subgroups. We encourage further evaluation of modeling in the search for more sensitive mortality end points.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Clermont, Gcler@pitt.eduCLER
Angus, DCangusdc@pitt.eduANGUSDC
Kalassian, KG
Linde-Zwirble, WT
Ramakrishnan, N
Linden, PK
Pinsky, MRpinsky@pitt.eduPINSKY
Date: 1 November 2003
Date Type: Publication
Journal or Publication Title: Critical Care Medicine
Volume: 31
Number: 11
Page Range: 2627 - 2633
DOI or Unique Handle: 10.1097/01.ccm.0000094233.35059.81
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0090-3493
PubMed ID: 14605534
Date Deposited: 05 Apr 2012 21:56
Last Modified: 19 Jan 2019 15:55
URI: http://d-scholarship.pitt.edu/id/eprint/11572

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