Late-onset sepsis (LOS) is a significant cause of mortality in preterm infants. The neonatal sequential organ failure assessment (nSOFA) provides an objective assessment of sepsis risk but requires manual calculation. We developed an EMR pipeline to automate nSOFA calculation for more granular analysis of score performance and to identify optimal alerting thresholds.
Infants born <33 weeks of gestation with LOS were included. A SQL-based pipeline calculated hourly nSOFA scores 48 h before/after sepsis evaluation. Sensitivity analysis identified the optimal timing and threshold of nSOFA for LOS mortality.
Eighty episodes of LOS were identified (67 survivors, 13 non-survivor). Non-survivors had persistently elevated nSOFA scores, markedly increasing 12 h prior to culture. At sepsis evaluation, the AUC for nSOFA >2 was 0.744 (p = 0.0047); thresholds of >3 and >4 produced lower AUCs.
nSOFA is persistently elevated for infants with LOS mortality compared to survivors with an optimal alert threshold >2.
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The datasets generated during and/or analyzed during the current study are not publicly available due to patient privacy restrictions. A limited and de-identified dataset may be available from the corresponding author on reasonable request.
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This project was supported by the following grants. NIH/NCATS UL1 TR002345, NIH/NINDS K23 NS111086.
No authors have no financial ties or potential/perceived competing financial interests in relation to this work.
This study was reviewed and approved under a waiver of consent per 45 CFR 46.104 by the Washington University Institutional Review Board.
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Husain, A.N., Eiden, E. & Vesoulis, Z.A. Use of an electronic medical record to optimize a neonatal sepsis score for mortality prediction. J Perinatol (2022). https://doi.org/10.1038/s41372-022-01573-5