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Customized Probability Models for Early Severe Sepsis in Adult Intensive Care Patients

  • J. R. Le Gall
  • S. Lemeshow
  • The ICU Scoring Group
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1996)

Abstract

The new drugs used in septic patients, such as anti-endotoxins or anti-cytokines, are often very expensive, but studies to evaluate their efficacy are complex and involve heterogeneous groups of patients. Therapeutic trials must be carefully designed to compare the placebo and the treated groups, but in spite of many well-conducted trials, the conclusions are often disappointing [1–3], due either to the inclusion criteria being too liberal or to a lack of stratification of patients by their probability of mortality. The use of probability models could improve such studies by enabling comparison of the two groups by risk of death categories. The aim of this study was to develop models for use in clinical trials of severe sepsis patients identified early in the ICU stay based on the Simplified Acute Physiology Score (SAPS II) [4] or the 24-h model of the Mortality Probability Model (MPM II) system, the MPM II24 [5].

Keywords

Severe Sepsis Sepsis Patient Acute Physiology Score Organ System Failure Severe Sepsis Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bone RC, Fisher CJ Jr, Clemmer TP, et al (1987) A controlled clinical trial of high dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 317: 653–658PubMedCrossRefGoogle Scholar
  2. 2.
    The Veterans Administration Systemic Sepsis Comparative Study Groups (1987) Effects of high dose glucocorticoid therapy on mortality in patients with clinical signs of sepsis. N Engl J Med 317: 659–665CrossRefGoogle Scholar
  3. 3.
    Ziegler EJ, Fisher CJ Jr, Sprung CL, et al (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. N Engl J Med 324: 429–436PubMedCrossRefGoogle Scholar
  4. 4.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270: 2957–2963PubMedCrossRefGoogle Scholar
  5. 5.
    Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J (1993) Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270: 2478–2486PubMedCrossRefGoogle Scholar
  6. 6.
    American College of Chest Physicians/Society of Critical Care Medicine (1992) Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874CrossRefGoogle Scholar
  7. 7.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 202: 685–692PubMedCrossRefGoogle Scholar
  8. 8.
    Hosmer DW, Lemeshow S (1989) Applied Logistic Regression. John Wiley & Sons, New YorkGoogle Scholar
  9. 9.
    Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143: 29–36PubMedGoogle Scholar
  10. 10.
    Knaus WA, Harrel FE, Fisher CJ, et al (1993) The clinical evaluation of new drugs for sepsis. A prospective study design based on survival analysis. JAMA 270: 1233–1241PubMedCrossRefGoogle Scholar
  11. 11.
    Selker HP (1993) Systems for comparing actual and predicted mortality rates: Characteristics to promote cooperation in improving hospital care. Ann Int Med 118: 820–821PubMedGoogle Scholar
  12. 12.
    Hosmer DW, Lemeshow S (1996) Confidence interval estimates of an index of quality performance based on logistic regression models. (In press)Google Scholar
  13. 13.
    Loirat P (1996) Critique of existing scoring systems: Admission scores. Intensive Care Med (In press)Google Scholar
  14. 14.
    Lemeshow S, Klar J, Teres D, et al (1996) Mortality Probability Models (MPM) for patients in the intensive care unit for 48 or 72 hours: A prospective, multicenter study. Crit Care Med (In press)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • J. R. Le Gall
  • S. Lemeshow
  • The ICU Scoring Group

There are no affiliations available

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