Development and performance of a novel vasopressor-driven mortality prediction model in septic shock

Saraschandra Vallabhajosyula, Jacob C. Jentzer, Aditya A. Kotecha, Dennis H. Murphree, Erin F. Barreto, Ashish K. Khanna, Vivek N. Iyer

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: Vasoactive medications are essential in septic shock, but are not fully incorporated into current mortality prediction risk scores. We sought to develop a novel mortality prediction model for septic shock incorporating quantitative vasoactive medication usage. Methods: Quantitative vasopressor use was calculated in a cohort of 5352 septic shock patients and compared using norepinephrine equivalents (NEE), cumulative vasopressor index and the vasoactive inotrope score models. Having best discrimination prediction, log10NEE was selected for further development of a novel prediction model for 28-day and 1-year mortality via backward stepwise logistic regression. This model termed ‘MAVIC’ (Mechanical ventilation, Acute Physiology And Chronic Health Evaluation-III, Vasopressors, Inotropes, Charlson comorbidity index) was then compared to Acute Physiology And Chronic Health Evaluation-III (APACHE-III) and Sequential Organ Failure Assessment (SOFA) scores in an independent validation cohort for its accuracy in predicting 28-day and 1-year mortality. Measurements and main results: The MAVIC model was superior to the APACHE-III and SOFA scores in its ability to predict 28-day mortality (area under receiver operating characteristic curve [AUROC] 0.73 vs. 0.66 and 0.60) and 1-year mortality (AUROC 0.74 vs. 0.66 and 0.60), respectively. Conclusions: The incorporation of quantitative vasopressor usage into a novel ‘MAVIC’ model results in superior 28-day and 1-year mortality risk prediction in a large cohort of patients with septic shock.

Original languageEnglish (US)
Article number112
JournalAnnals of Intensive Care
Volume8
Issue number1
DOIs
StatePublished - Dec 1 2018

Keywords

  • Inotropes
  • MAVIC model
  • Norepinephrine
  • Septic shock
  • Vasopressors

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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