A neonatal sequential organ failure assessment score predicts mortality to late-onset sepsis in preterm very low birth weight infants

Abstract

Background: An operational definition of organ dysfunction applicable to neonates that predicts mortality in the setting of infection is lacking. We determined the utility of an objective, electronic health record (EHR)-automated, neonatal sequential organ failure assessment (nSOFA) score to predict mortality from late-onset sepsis (LOS) in premature, very low birth weight (VLBW) infants.

Methods: Retrospective, single-center study of bacteremic preterm VLBW newborns admitted between 2012 and 2016. nSOFA scores were derived for patients with LOS at multiple time points surrounding the sepsis evaluation.

Results: nSOFA scores at evaluation and at all points measured after evaluation were different between survivors and non-survivors. Among patients with an nSOFA score of >4, mortality was higher at evaluation (13% vs 67%, p < 0.001), +6 h (15% vs 64%, p = 0.002), and +12 h (7% vs 71%, p < 0.001) as compared to patients with a score of ≤4. Receiver operating characteristics area under the curve was 0.77 at evaluation (95% CI 0.62-0.92; p = 0.001), 0.78 at +6 h (0.66-0.92; p < 0.001), and 0.93 at +12 h (0.86-0.997; p < 0.001).

Conclusions: The nSOFA scoring system predicted mortality in VLBW infants with LOS and this automated system was integrated into our EHR. Prediction of LOS mortality is a critical step toward improvements in neonatal sepsis outcomes.

Conflict of interest statement

Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1.. Neonatal sequential organ failure (nSOFA) total scores among survivors and non-survivors around sepsis episode.

All data points shown for both groups at all time points. Median values and interquartile ranges shown.

Figure 2.. Mortality risk based on the nSOFA maximum at evaluation or +6 hours.

Mortality (%) was determined by using the maximum nSOFA value measured at evaluation or +6 hours among the 44 survivors and 16 non-survivors.

Figure 3.. The change in nSOFA scores among sepsis survivors and non-survivors.

Each symbol represents the intra-individual difference in nSOFA scores between the respective time points (nSOFAΔ). Median values and interquartile ranges shown. If mortality occurred prior to a timed score, then the most proximal nSOFA score was substituted to allow calculations.

Figure 4.. Receiver operating characteristics curve for nSOFA to predict mortality at the specified timepoints.

Area under the curve (AUC) was 0.77 at evaluation (95% CI 0.62–0.92; p=0.001), 0.79 at +6 hours (0.66–0.92; p