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Use of an electronic medical record to optimize a neonatal sepsis score for mortality prediction

Journal of Perinatology volume 43, pages 746–751 (2023)Cite this article

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Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

nSOFA is persistently elevated for infants with LOS mortality compared to survivors with an optimal alert threshold >2.

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Fig. 1: Total nSOFA scores before and after sepsis evaluation.
Fig. 2: Mortality prediction AUC by threshold and time.

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Data availability

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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Funding

This project was supported by the following grants. NIH/NCATS UL1 TR002345, NIH/NINDS K23 NS111086.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Ameena N. Husain & Zachary A. Vesoulis

  2. Institute for Informatics, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Elise Eiden

Authors
  1. Ameena N. Husain
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  3. Zachary A. Vesoulis
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Contributions

AH and ZAV conceived the project; AH and EE acquired the data; AH, EE, and ZAV contributed to the analysis of the data; AH wrote the initial draft of the manuscript; EE and ZAV critically revised the manuscript. All authors have reviewed and approved the final version to be published. The authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Zachary A. Vesoulis.

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Competing interests

No authors have no financial ties or potential/perceived competing financial interests in relation to this work.

Ethics approval

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 43, 746–751 (2023). https://doi.org/10.1038/s41372-022-01573-5

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