RT Journal Article
SR Electronic
T1 New clinical prediction model for early recognition of sepsis in adult primary care patients: a prospective diagnostic cohort study of development and external validation
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e437
OP e445
DO 10.3399/BJGP.2021.0520
VO 72
IS 719
A1 Feike J Loots
A1 Marleen Smits
A1 Rogier M Hopstaken
A1 Kevin Jenniskens
A1 Fleur H Schroeten
A1 Ann van den Bruel
A1 Alma C van de Pol
A1 Jan Jelrik Oosterheert
A1 Hjalmar Bouma
A1 Paul Little
A1 Michael Moore
A1 Sanne van Delft
A1 Douwe Rijpsma
A1 Joris Holkenborg
A1 Bas CT van Bussel
A1 Ralph Laven
A1 Dennis CJJ Bergmans
A1 Jacobien J Hoogerwerf
A1 Gideon HP Latten
A1 Eefje GPM de Bont
A1 Paul Giesen
A1 Annemarie den Harder
A1 Ron Kusters
A1 Arthur RH van Zanten
A1 Theo JM Verheij
YR 2022
UL http://bjgp.org/content/72/719/e437.abstract
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.