Stics and ICU outcome of patients admitted with severe sepsis and compared them with patients who develop severe sepsis after admission to the PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20719924 ICU. Method: The Riyadh Intensive Care Tanshinone I Program (RIP) database 1989?996 contains 28 094 complete demographic data, daily APACHE II and TISS scores from 21 UK ICUs. 2790 patients retrospectively satisfied the criteria of severe sepsis and multiple organ failure. Results: See Table. Conclusion: The timing of development of severe sepsis and multiple organ failure appears to be an important factor for outcome with a significantly higher mortality among those admitted with sepsis. The admission APACHE II score and the score on the day of development of sepsis were lower among those who developed sepsis. This may be attributable to these patients already being in the ICU environment and thus receiving closer monitoring and more timely intervention. This finding may be of importance in the design of future trials to evaluate new treatment modalities.n ( ) Mean age (SD)2790 60.2 (16.7)1162 (41.6 ) 1628 (58.4 ) 58.5 (17.7) 19.1(7.1) 19.7 (6.9) 2.2 (0.5) 61.5 (15.9) <0.001 23.2 (7.5) <0.001 24.7 (7.2) <0.001 2.4 (0.7) <0.Admission Apache 21.5 (7.6) II (SD) Apache II on 1st day of sepsis (SD) No organ failures (SD) 22.6 (7.5) 2.3 (0.6)Differences between those admitted with and those that developed sepsis Admitted with n ( ) Mortality ( ) Mean age (SD) Admission Apache II (SD) No organ failure (SD) 782 (28 ) 491 (62.8 ) 59 (17.3) 25.8 (7.2) 2.5 (0.7) Developed 2008 (72 ) 1137 (56.6) 60.7 (16.5) 19.8 (7.0) 21.4 (7.2) 2.3 (0.7) 0.003 0.01 <0.001 <0.001 <0.001 PDay of sepsis Apache II(SD) 25.8 (7.2)P255 Important factors for the modelling and design of clinical trials for severe sepsis and multiple organ failureL Shaikh, H Stuart, A Rhodes and RW Chang for the RIP Users Group Dept of Intensive Care, St George's Hospital, London, SW17 0QT, UK. Fax 0181 7679748 Crit Care 1999, 3 (suppl 1):P255 Introduction: No large, well-controlled, trial has been able to demonstrate a statistically significant and reproducible benefit of experimental treatment in severe sepsis and multiple organ failure. This study was done to determine the factors that have to be controlled for in future design of clinical trials in sepsis. Method: 2790 patients from the RIP database satisfied the criteria of severe sepsis and multiple organ failure. Logistic regression Outcome Number of organ failures 2 3 APACHE II Score [3?7] Treating centre 1,7,19 2,3,11,13,18,20 APACHE II Score [3?4] [14?3] [23?5] [3?4] 4,5,6,9,14,15,17,21 8,10,12,16 APACHE II Score [14?7] [17?5] [25?2] [32?5] Admitted Developed [17?8] [28?5]APACHE II Score [3?4] [14?9] [19?5]Poster abstractsanalysis was carried out to determine the factors that influenced ICU outcome. The CHAID model of an expert system AnswerTree (SPSS, UK) was also used to derive decision rules that govern the outcome of these patients. Results: Of the eight independent variables entered into the logistic regression analysis four in order of importance were selected: APACHE II score on the day of development of sepsis, treating centre, number of organ failures, age. The area under ROC was0.75. The level and branches of the decision rules by the expert system is shown in the Figure on the previous page. The difference in outcome for all the nodes is P < 0.0001 Conclusion: As the area under the curve of the ROC = 0.75, one is unlikely to use logistical regression analysis to risk stratify patients for fu.
