Youn-Jung Kim1, Jihoon Kang2, Min-Ju Kim3, Seung Mok Ryoo1, Gu Hyun Kang4, Tae Gun Shin5, Yoo Seok Park6, Sung-Hyuk Choi7, Woon Yong Kwon8, Sung Phil Chung6, Won Young Kim9. 1. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. 2. Department of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea. 4. Department of Emergency Medicine, Hallym University College of Medicine, Seoul, South Korea. 5. Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 6. Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea. 7. Department of Emergency Medicine, Guro Hospital, Korea University Medical Center, Seoul, South Korea. 8. Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. 9. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. wonpia73@naver.com.
Abstract
BACKGROUND: Clinical decision-making of invasive high-intensity care for critically ill stage IV cancer patients in the emergency department (ED) is challenging. A reliable and clinically available prognostic score for advanced cancer patients with septic shock presented at ED is essential to improve the quality of intensive care unit care. This study aimed to develop a new prognostic score for advanced solid cancer patients with septic shock available early in the ED and to compare the performance to the previous severity scores. METHODS: This multi-center, prospective cohort study included consecutive adult septic shock patients with stage IV solid cancer. A new scoring system for 28-day mortality was developed and validated using the data of development (January 2016 to December 2017; n = 469) and validation sets (January 2018 to June 2019; n = 428). The developed score's performance was compared to that of the previous severity scores. RESULTS: New scoring system for 28-day mortality was based on six variables (score range, 0-8): vital signs at ED presentation (respiratory rate, body temperature, and altered mentation), lung cancer type, and two laboratory values (lactate and albumin) in septic shock (VitaL CLASS). The C-statistic of the VitaL CLASS score was 0.808 in the development set and 0.736 in the validation set, that is superior to that of the Sequential Organ Failure Assessment score (0.656, p = 0.01) and similar to that of the Acute Physiology and Chronic Health Evaluation II score (0.682, p = 0.08). This score could identify 41% of patients with a low-risk group (observed 28-day mortality, 10.3%) and 7% of patients with a high-risk group (observed 28-day mortality, 73.3%). CONCLUSIONS: The VitaL CLASS score could be used for both risk stratification and as part of a shared clinical decision-making strategy for stage IV solid cancer patients with septic shock admitting at ED within several hours.
BACKGROUND: Clinical decision-making of invasive high-intensity care for critically ill stage IV cancerpatients in the emergency department (ED) is challenging. A reliable and clinically available prognostic score for advanced cancerpatients with septic shock presented at ED is essential to improve the quality of intensive care unit care. This study aimed to develop a new prognostic score for advanced solid cancerpatients with septic shock available early in the ED and to compare the performance to the previous severity scores. METHODS: This multi-center, prospective cohort study included consecutive adult septic shockpatients with stage IV solid cancer. A new scoring system for 28-day mortality was developed and validated using the data of development (January 2016 to December 2017; n = 469) and validation sets (January 2018 to June 2019; n = 428). The developed score's performance was compared to that of the previous severity scores. RESULTS: New scoring system for 28-day mortality was based on six variables (score range, 0-8): vital signs at ED presentation (respiratory rate, body temperature, and altered mentation), lung cancer type, and two laboratory values (lactate and albumin) in septic shock (VitaL CLASS). The C-statistic of the VitaL CLASS score was 0.808 in the development set and 0.736 in the validation set, that is superior to that of the Sequential Organ Failure Assessment score (0.656, p = 0.01) and similar to that of the Acute Physiology and Chronic Health Evaluation II score (0.682, p = 0.08). This score could identify 41% of patients with a low-risk group (observed 28-day mortality, 10.3%) and 7% of patients with a high-risk group (observed 28-day mortality, 73.3%). CONCLUSIONS: The VitaL CLASS score could be used for both risk stratification and as part of a shared clinical decision-making strategy for stage IV solid cancerpatients with septic shock admitting at ED within several hours.
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