Dynamic assessment of clinical scales for predicting mortality in septic patients with prolonged ICU stay

Introduction. Sepsis remains one of the leading causes of mortality in intensive care units (ICU). Assessing the risk of fatal outcomes is crucial for clinical decision-making and improving treatment outcomes.

The objective was to determine the prognostic significance of clinical scales assessed in dynamics for predicting mortality in septic ICU patients who are predominantly in prolonged and chronic critical illness.

Materials and methods. A single-center retrospective study was conducted using data from the RICD v2.0 database. The prognostic significance of the APACHE II, NUTRIC, SOFA scales, SIRS criteria, and PNI index was assessed dynamically, with focus on time to the fatal outcome. Sepsis was diagnosed using Sepsis-3 criteria. The primary endpoint was the area under the ROC curve (AUROC).

Results. The study included 52 sepsis patients (33 men, median age was 60 years old, median ICU stay was 57 days, mortality rate was 11.5%). The highest prognostic effectiveness was found for the APACHE II and NUTRIC scales when assessed 1–14 days before the fatal outcome (AUROC 0.91 and 0.90, respectively). For assessments conducted ≥ 15 days before the fatal outcome, prognostic significance was maintained only for the NUTRIC scale (≥ 6 points, AUROC 0.82). Both APACHE II and NUTRIC scales demonstrated high negative predictive value, allowing effective identification of patients with low mortality risk.

Conclusions. Dynamic assessment of the APACHE II and NUTRIC scales is important for predicting mortality in sepsis patients with prolonged ICU stays. The NUTRIC scale retains its prognostic value when assessed ≥ 15 days before the fatal outcome, confirming its role in long-term monitoring of septic patients.

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