The Values Of Howell-PIRO Model In Predicting In-hospital Mortality For Patients With Severe Sepsis Or Septic Shock

ObjectiveTo investigate the values of the Howell-PIRO(Predisposition, Infection, Response, Organ dysfunction) model in predicting in-hospital mortality for patients presenting to the Emergency Intensive Care Unit(EICU) with severe sepsis or septic shock. MethodsClinical data of patients admitted to EICU of the First Affiliated Hospital of Anhui Medical University from June 2012 to June 2013 were retrospectively researched. APACHE II、Howell-PIRO and SOFA scores were respectively calculated from EICU data. Analysis compared areas under the receiver operator characteristic(ROC) curves for 28-day prognosis. Results A total of 123 enrolled patients, severe sepsis group was 102(83%), septic shock group was 21(17%).The 28-day mortality, lactic acid, PCT, Howell-PIRO and SOFA score of septic shock group were statistically significant higher than those of severe sepsis group but the mean arterial pressure was statistically significant lower.The age,sex ratio, length of hospital stay, body temperature, pulse, respiration, the percentage of mechanical ventilation, APACHE II score and CRP of the two groups were no statistically significant difference.Compared with the two groups:there were significant differences in Howell-PIRO scores(16±3)vs(19±3) and SOFA scores(7±3)vs(10±3)(P<0.05),but it was no obvious difference in APACHE II scores(20±8)vs(24±9)(P=0.058).ROC curve drawing according to the prognosis of 28-day : the area under the curve of Howell-PIRO scores was 0.816(95% CI 0.736 to 0.880),the sensitivity was 81.40%,specificity was 64.86%,the best cut-off values was 17(P<0.0001); the area under the curve of APACHE II scores was 0.703(95% CI 0.614 to 0.782),the sensitivity was 88.37%,specificity was 49.95%,the best cut-off values was 27(P=0.0001);the area under the curve of SOFA scores was 0.802(95% CI 0.721 to 0.869),the sensitivity was 68.60%,specificity was 81.80%,the best cut-off values was 7(P<0.0001);There were no obvious differences in pairwise comparisons of the three scores(P>0.05).The patients was divided into surviving group(86 cases) and death group(37 cases) according to the 28 days’ prognosis,thirty-seven(30%) patients died within 28 days of presentation;The age,lactic acid,Howell-PIRO, APACHE II and SOFA score of death group were statistically significant higher than those of surviving group.The sex ratio,CRP and PCT of the two groups were no statistically significant difference.Mortality increased with increasing scores. ConclusionsThe Howell-PIRO model was better to predict mortality in EICU patients with severe sepsis and septic shock. And the sensitivity was superior to SOFA score,specificity was superior to APACHE II score.