Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic s
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RESEARCH ARTICLE
Open Access
Development and validation of the VitaL CLASS score to predict mortality in stage IV solid cancer patients with septic shock in the emergency department: a multi-center, prospective cohort study 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 Kim1* on behalf of the Korean Shock Society (KoSS) Investigators
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%). (Continued on next page)
* Correspondence: [email protected] † Youn-Jung Kim and Jihoon Kang contributed equally to this work. 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 Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in
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