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Validation of the REGARDS Severe Sepsis Risk Score

1
Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
2
Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA
3
Department of Critical Care Medicine, University of Pittsburgh, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15213, USA
4
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
5
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
6
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
7
Department of Health Research and Policy, Stanford University, Stanford, CA 94305, USA
8
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
9
Department of Medicine, Weill-Cornell Medical Center, New York, NY 10065, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(12), 536; https://doi.org/10.3390/jcm7120536
Received: 5 November 2018 / Revised: 4 December 2018 / Accepted: 7 December 2018 / Published: 11 December 2018
(This article belongs to the Section Hematology)
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Abstract

There are no validated systems for characterizing long-term risk of severe sepsis in community-dwelling adults. We tested the ability of the REasons for Geographic and Racial Differences in Stroke-Severe Sepsis Risk Score (REGARDS-SSRS) to predict 10-year severe sepsis risk in separate cohorts of community-dwelling adults. We internally tested the REGARDS-SSRS on the REGARDS-Medicare subcohort. We then externally validated the REGARDS-SSRS using (1) the Cardiovascular Health Study (CHS) and (2) the Atherosclerosis Risk in Communities (ARIC) cohorts. Participants included community-dwelling adults: REGARDS-Medicare, age ≥65 years, n = 9522; CHS, age ≥65 years, n = 5888; ARIC, age 45–64 years, n = 11,584. The primary exposure was 10-year severe sepsis risk, predicted by the REGARDS-SSRS from participant sociodemographics, health behaviors, chronic medical conditions and select biomarkers. The primary outcome was first severe sepsis hospitalizations, defined as the concurrent presence of ICD-9 discharge diagnoses for a serious infection and organ dysfunction. Median SSRS in the cohorts were: REGARDS-Medicare 11 points (IQR 7–16), CHS 10 (IQR 6–15), ARIC 7 (IQR 5–10). Severe sepsis incidence rates were: REGARDS-Medicare 30.7 per 1000 person-years (95% CI: 29.2–32.2); CHS 11.9 (10.9–12.9); ARIC 6.8 (6.3–7.3). SSRS discrimination for first severe sepsis events were: REGARDS-Medicare C-statistic 0.704 (95% CI: 0.691–0.718), CHS 0.696 (0.675–0.716), ARIC 0.697 (0.677–0.716). The REGARDS-SRSS may potentially play a role in identifying community-dwelling adults at high severe sepsis risk. View Full-Text
Keywords: sepsis; infections; risk prediction; outcomes sepsis; infections; risk prediction; outcomes
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Wang, H.E.; Donnelly, J.P.; Yende, S.; Levitan, E.B.; Shapiro, N.I.; Dai, Y.; Zhao, H.; Heiss, G.; Odden, M.; Newman, A.; Safford, M. Validation of the REGARDS Severe Sepsis Risk Score. J. Clin. Med. 2018, 7, 536.

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