Four Assessment Tools for Predicting Mortality and Adverse Events in Surgical Patients With Sepsis and Septic Shock: A Comparative Study

10.1097/jnr.0000000000000574

Yi-Chin CHU；Yi LIU；Shih-Feng WENG；Chao-Wen CHEN

critical care ； surgical patients ； mortality ； sepsis adverse events ； assessment tools

The Journal of Nursing Research

31卷5期（2023 / 10 / 01）

1 - 9

英文

Background: The mortality rate for sepsis and septic shock in surgical patients is approximately 36%, which is higher than that of other medical patients. Predisposition, infection/injury, response, and organ dysfunction (PIRO) is currently the most widely used tool for assessing patients with surgical sepsis. However, it is not a standardized assessment tool for surgical patients in general. Purpose: The purposes of this study were to (a) create a modified PIRO (mPIRO) that adds a count of platelets and does not include a body temperature reading; (b) test the sensitivity and specificity of the mPIRO for predicting mortality and adverse events among patients with surgical sepsis; and (c) compare the predictive accuracy of the mPIRO, sequential organ failure assessment (SOFA), quick SOFA, and PIRO tools. Methods: A retrospective observational cohort study was conducted. Two thousand fifty-five patient medical records were reviewed, with 103 identified as meeting the inclusion criteria. Results: Compared with the other tools, mPIRO ≥ 4 achieved better sensitivity (90.5%) in predicting mortality and high sensitivity (72%) and specificity (80%) in predicting adverse events. mPIRO was the most accurate predictor of mortality (area under the receiver operating characteristic curve [AUC] = 0.83) among the tools considered. SOFA and mPIRO were the first and second most accurate predictor of adverse events, respectively, with respective AUC values of 0.86 and 0.82. Conclusions/Implications for Practice: mPIRO, which employs an easy-to-use scoring system, is a valid assessment tool with good sensitivity and AUC for predicting both mortality and adverse events in patients with surgical sepsis. We recommend using mPIRO ≥ 3 as an indicator of potential adverse events.

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