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VOLUME 28 , ISSUE 10 ( October, 2024 ) > List of Articles

Original Article

Developing Augmented Pro-SOFA and Pro-SAPS Models by Integrating Biomarkers PCT, NLR, and CRP with SOFA and SAPS-III Scores

Anandakrishnan Nandakumar, Shashank Sudeep, Aryalakshmi Chakkalamparambath Sreemohan, Sreedhar Vijayakumar, Gayathri Jayasree Sudhakaran, Georg Gutjahr, Rahul K Pathinaruporthi, Sabarish Balachandran, Subash Chandra, Shyam Sundar Purushothaman, Zubair U Mohamed, Sashi N Nair, Merlin Moni, Dipu T Sathyapalan

Keywords : Augmented models, Biomarkers, C-reactive protein, Intensive care unit, Neutrophil-to-lymphocyte ratio, Procalcitonin, Simplified acute physiology score III, Sequential organ failure assessment

Citation Information : Nandakumar A, Sudeep S, Sreemohan AC, Vijayakumar S, Sudhakaran GJ, Gutjahr G, Pathinaruporthi RK, Balachandran S, Chandra S, Purushothaman SS, Mohamed ZU, Nair SN, Moni M, Sathyapalan DT. Developing Augmented Pro-SOFA and Pro-SAPS Models by Integrating Biomarkers PCT, NLR, and CRP with SOFA and SAPS-III Scores. Indian J Crit Care Med 2024; 28 (10):935-941.

DOI: 10.5005/jp-journals-10071-24807

License: CC BY-NC 4.0

Published Online: 30-09-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Sepsis, a life-threatening condition characterized by a dysregulated immune response to infection, remains a significant clinical challenge globally. This study aims to enhance the predictive accuracy of existing sepsis severity scores by developing augmented versions of the SOFA and SAPS-III models, termed Pro-SOFA and Pro-SAPS, through the integration of biomarkers procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP). Methods: This prospective observational study was conducted in the medical ICU of a tertiary care hospital in southern India from August 2022 to December 2023. A total of 301 adult patients suspected or confirmed to have sepsis were assessed for eligibility, with 171 patients completing the study. Demographic and clinical data were collected; SOFA and SAPS-III scores were calculated and augmented with PCT, NLR, and CRP to develop Pro-SOFA and Pro-SAPS models. The performance of these models was evaluated using Brier scores, AUC, and net reclassification index (NRI). Results: The augmented Pro-SOFA and Pro-SAPS models demonstrated superior predictive accuracy compared to their original counterparts. The Brier scores for Pro-SOFA and Pro-SAPS were 0.181 and 0.165, respectively, indicating better calibration than the original scores. The Pro-SAPS showed significant improvement over the original SAPS-III score (NRI = 0.50, SE = 0.14, p < 0.01). Similarly, Pro-SOFA outperformed the original SOFA (NRI = 0.49, SE = 0.13, p < 0.01). Conclusion and clinical significance: Integrating PCT, CRP, and NLR with SOFA and SAPS-III scores to develop Pro-SOFA and Pro-SAPS significantly improves the predictive accuracy for sepsis mortality and can thus potentially improve sepsis outcomes.

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