New clinical prediction model for early recognition of sepsis in adult primary care patients: a prospective diagnostic cohort study of development and external validation

Feike J Loots; Marleen Smits; Rogier M Hopstaken; Kevin Jenniskens; Fleur H Schroeten; Ann van den Bruel; Alma C van de Pol; Jan Jelrik Oosterheert; Hjalmar Bouma; Paul Little; Michael Moore; Sanne van Delft; Douwe Rijpsma; Joris Holkenborg; Bas Ct van Bussel; Ralph Laven; Dennis Cjj Bergmans; Jacobien J Hoogerwerf; Gideon Hp Latten; Eefje Gpm de Bont; Paul Giesen; Annemarie den Harder; Ron Kusters; Arthur Rh van Zanten; Theo Jm Verheij

doi:10.3399/BJGP.2021.0520

New clinical prediction model for early recognition of sepsis in adult primary care patients: a prospective diagnostic cohort study of development and external validation

Feike J Loots^*, Marleen Smits, Rogier M Hopstaken, Kevin Jenniskens, Fleur H Schroeten, Ann van den Bruel, Alma C van de Pol, Jan Jelrik Oosterheert, Hjalmar Bouma, Paul Little, Michael Moore, Sanne van Delft, Douwe Rijpsma, Joris Holkenborg, Bas Ct van Bussel, Ralph Laven, Dennis Cjj Bergmans, Jacobien J Hoogerwerf, Gideon Hp Latten, Eefje Gpm de BontPaul Giesen, Annemarie den Harder, Ron Kusters, Arthur Rh van Zanten, Theo Jm Verheij

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Recognising patients who need immediate hospital treatment for sepsis while simultaneously limiting unnecessary referrals is challenging for GPs.

AIM: To develop and validate a sepsis prediction model for adult patients in primary care.

DESIGN AND SETTING: This was a prospective cohort study in four out-of-hours primary care services in the Netherlands, conducted between June 2018 and March 2020.

METHOD: Adult patients who were acutely ill and received home visits were included. A total of nine clinical variables were selected as candidate predictors, next to the biomarkers C-reactive protein, procalcitonin, and lactate. The primary endpoint was sepsis within 72 hours of inclusion, as established by an expert panel. Multivariable logistic regression with backwards selection was used to design an optimal model with continuous clinical variables. The added value of the biomarkers was evaluated. Subsequently, a simple model using single cut-off points of continuous variables was developed and externally validated in two emergency department populations.

RESULTS: A total of 357 patients were included with a median age of 80 years (interquartile range 71-86), of which 151 (42%) were diagnosed with sepsis. A model based on a simple count of one point for each of six variables (aged >65 years; temperature >38°C; systolic blood pressure ≤110 mmHg; heart rate >110/min; saturation ≤95%; and altered mental status) had good discrimination and calibration (C-statistic of 0.80 [95% confidence interval = 0.75 to 0.84]; Brier score 0.175). Biomarkers did not improve the performance of the model and were therefore not included. The model was robust during external validation.

CONCLUSION: Based on this study's GP out-of-hours population, a simple model can accurately predict sepsis in acutely ill adult patients using readily available clinical parameters.

Original language	English
Pages (from-to)	E437-E445
Number of pages	9
Journal	British Journal of General Practice
Volume	72
Issue number	719
Early online date	19 Apr 2022
DOIs	https://doi.org/10.3399/BJGP.2021.0520
Publication status	Published - Jun 2022

Keywords

CAMPAIGN
GUIDELINES
INTERNATIONAL CONSENSUS DEFINITIONS
ORGAN FAILURE
PERFORMANCE
SCORE
after-hours care
clinical decision rule
diagnosis
general practice
sepsis
vital signs

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Cite this

Loots, F. J., Smits, M., Hopstaken, R. M., Jenniskens, K., Schroeten, F. H., van den Bruel, A., van de Pol, A. C., Oosterheert, J. J., Bouma, H., Little, P., Moore, M., van Delft, S., Rijpsma, D., Holkenborg, J., van Bussel, B. C., Laven, R., Bergmans, D. C., Hoogerwerf, J. J., Latten, G. H., ... Verheij, T. J. (2022). New clinical prediction model for early recognition of sepsis in adult primary care patients: a prospective diagnostic cohort study of development and external validation. British Journal of General Practice, 72(719), E437-E445. https://doi.org/10.3399/BJGP.2021.0520

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title = "New clinical prediction model for early recognition of sepsis in adult primary care patients: a prospective diagnostic cohort study of development and external validation",

abstract = "BACKGROUND: Recognising patients who need immediate hospital treatment for sepsis while simultaneously limiting unnecessary referrals is challenging for GPs.AIM: To develop and validate a sepsis prediction model for adult patients in primary care.DESIGN AND SETTING: This was a prospective cohort study in four out-of-hours primary care services in the Netherlands, conducted between June 2018 and March 2020.METHOD: Adult patients who were acutely ill and received home visits were included. A total of nine clinical variables were selected as candidate predictors, next to the biomarkers C-reactive protein, procalcitonin, and lactate. The primary endpoint was sepsis within 72 hours of inclusion, as established by an expert panel. Multivariable logistic regression with backwards selection was used to design an optimal model with continuous clinical variables. The added value of the biomarkers was evaluated. Subsequently, a simple model using single cut-off points of continuous variables was developed and externally validated in two emergency department populations.RESULTS: A total of 357 patients were included with a median age of 80 years (interquartile range 71-86), of which 151 (42%) were diagnosed with sepsis. A model based on a simple count of one point for each of six variables (aged >65 years; temperature >38°C; systolic blood pressure ≤110 mmHg; heart rate >110/min; saturation ≤95%; and altered mental status) had good discrimination and calibration (C-statistic of 0.80 [95% confidence interval = 0.75 to 0.84]; Brier score 0.175). Biomarkers did not improve the performance of the model and were therefore not included. The model was robust during external validation.CONCLUSION: Based on this study's GP out-of-hours population, a simple model can accurately predict sepsis in acutely ill adult patients using readily available clinical parameters.",

keywords = "CAMPAIGN, GUIDELINES, INTERNATIONAL CONSENSUS DEFINITIONS, ORGAN FAILURE, PERFORMANCE, SCORE, after-hours care, clinical decision rule, diagnosis, general practice, sepsis, vital signs",

author = "Loots, {Feike J} and Marleen Smits and Hopstaken, {Rogier M} and Kevin Jenniskens and Schroeten, {Fleur H} and {van den Bruel}, Ann and {van de Pol}, {Alma C} and Oosterheert, {Jan Jelrik} and Hjalmar Bouma and Paul Little and Michael Moore and {van Delft}, Sanne and Douwe Rijpsma and Joris Holkenborg and {van Bussel}, {Bas Ct} and Ralph Laven and Bergmans, {Dennis Cjj} and Hoogerwerf, {Jacobien J} and Latten, {Gideon Hp} and {de Bont}, {Eefje Gpm} and Paul Giesen and Harder, {Annemarie den} and Ron Kusters and {van Zanten}, {Arthur Rh} and Verheij, {Theo Jm}",

note = "{\textcopyright} The Authors.",

year = "2022",

month = jun,

doi = "10.3399/BJGP.2021.0520",

language = "English",

volume = "72",

pages = "E437--E445",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "719",

}

Loots, FJ, Smits, M, Hopstaken, RM, Jenniskens, K, Schroeten, FH, van den Bruel, A, van de Pol, AC, Oosterheert, JJ, Bouma, H, Little, P, Moore, M, van Delft, S, Rijpsma, D, Holkenborg, J, van Bussel, BC, Laven, R, Bergmans, DC, Hoogerwerf, JJ, Latten, GH, de Bont, EG, Giesen, P, Harder, AD, Kusters, R, van Zanten, AR & Verheij, TJ 2022, 'New clinical prediction model for early recognition of sepsis in adult primary care patients: a prospective diagnostic cohort study of development and external validation', British Journal of General Practice, vol. 72, no. 719, pp. E437-E445. https://doi.org/10.3399/BJGP.2021.0520

New clinical prediction model for early recognition of sepsis in adult primary care patients: a prospective diagnostic cohort study of development and external validation. / Loots, Feike J; Smits, Marleen; Hopstaken, Rogier M et al.
In: British Journal of General Practice, Vol. 72, No. 719, 06.2022, p. E437-E445.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - New clinical prediction model for early recognition of sepsis in adult primary care patients

T2 - a prospective diagnostic cohort study of development and external validation

AU - Loots, Feike J

AU - Smits, Marleen

AU - Hopstaken, Rogier M

AU - Jenniskens, Kevin

AU - Schroeten, Fleur H

AU - van den Bruel, Ann

AU - van de Pol, Alma C

AU - Oosterheert, Jan Jelrik

AU - Bouma, Hjalmar

AU - Little, Paul

AU - Moore, Michael

AU - van Delft, Sanne

AU - Rijpsma, Douwe

AU - Holkenborg, Joris

AU - van Bussel, Bas Ct

AU - Laven, Ralph

AU - Bergmans, Dennis Cjj

AU - Hoogerwerf, Jacobien J

AU - Latten, Gideon Hp

AU - de Bont, Eefje Gpm

AU - Giesen, Paul

AU - Harder, Annemarie den

AU - Kusters, Ron

AU - van Zanten, Arthur Rh

AU - Verheij, Theo Jm

PY - 2022/6

Y1 - 2022/6

N2 - BACKGROUND: Recognising patients who need immediate hospital treatment for sepsis while simultaneously limiting unnecessary referrals is challenging for GPs.AIM: To develop and validate a sepsis prediction model for adult patients in primary care.DESIGN AND SETTING: This was a prospective cohort study in four out-of-hours primary care services in the Netherlands, conducted between June 2018 and March 2020.METHOD: Adult patients who were acutely ill and received home visits were included. A total of nine clinical variables were selected as candidate predictors, next to the biomarkers C-reactive protein, procalcitonin, and lactate. The primary endpoint was sepsis within 72 hours of inclusion, as established by an expert panel. Multivariable logistic regression with backwards selection was used to design an optimal model with continuous clinical variables. The added value of the biomarkers was evaluated. Subsequently, a simple model using single cut-off points of continuous variables was developed and externally validated in two emergency department populations.RESULTS: A total of 357 patients were included with a median age of 80 years (interquartile range 71-86), of which 151 (42%) were diagnosed with sepsis. A model based on a simple count of one point for each of six variables (aged >65 years; temperature >38°C; systolic blood pressure ≤110 mmHg; heart rate >110/min; saturation ≤95%; and altered mental status) had good discrimination and calibration (C-statistic of 0.80 [95% confidence interval = 0.75 to 0.84]; Brier score 0.175). Biomarkers did not improve the performance of the model and were therefore not included. The model was robust during external validation.CONCLUSION: Based on this study's GP out-of-hours population, a simple model can accurately predict sepsis in acutely ill adult patients using readily available clinical parameters.

AB - BACKGROUND: Recognising patients who need immediate hospital treatment for sepsis while simultaneously limiting unnecessary referrals is challenging for GPs.AIM: To develop and validate a sepsis prediction model for adult patients in primary care.DESIGN AND SETTING: This was a prospective cohort study in four out-of-hours primary care services in the Netherlands, conducted between June 2018 and March 2020.METHOD: Adult patients who were acutely ill and received home visits were included. A total of nine clinical variables were selected as candidate predictors, next to the biomarkers C-reactive protein, procalcitonin, and lactate. The primary endpoint was sepsis within 72 hours of inclusion, as established by an expert panel. Multivariable logistic regression with backwards selection was used to design an optimal model with continuous clinical variables. The added value of the biomarkers was evaluated. Subsequently, a simple model using single cut-off points of continuous variables was developed and externally validated in two emergency department populations.RESULTS: A total of 357 patients were included with a median age of 80 years (interquartile range 71-86), of which 151 (42%) were diagnosed with sepsis. A model based on a simple count of one point for each of six variables (aged >65 years; temperature >38°C; systolic blood pressure ≤110 mmHg; heart rate >110/min; saturation ≤95%; and altered mental status) had good discrimination and calibration (C-statistic of 0.80 [95% confidence interval = 0.75 to 0.84]; Brier score 0.175). Biomarkers did not improve the performance of the model and were therefore not included. The model was robust during external validation.CONCLUSION: Based on this study's GP out-of-hours population, a simple model can accurately predict sepsis in acutely ill adult patients using readily available clinical parameters.

KW - CAMPAIGN

KW - GUIDELINES

KW - INTERNATIONAL CONSENSUS DEFINITIONS

KW - ORGAN FAILURE

KW - PERFORMANCE

KW - SCORE

KW - after-hours care

KW - clinical decision rule

KW - diagnosis

KW - general practice

KW - sepsis

KW - vital signs

U2 - 10.3399/BJGP.2021.0520

DO - 10.3399/BJGP.2021.0520

M3 - Article

C2 - 35440467

SN - 0960-1643

VL - 72

SP - E437-E445

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 719

ER -