The accuracy of clinical prediction of prognosis for patients admitted with sepsis to internal medicine departments

<div><p></p><p><b>Introduction</b> Prognosis estimation offered by physicians for patients inflicted by sepsis on their admission to Internal Medicine (IM) departments is considered a challenge. Early prognosis estimation is critical and determines the intensity of treatment offered. The accuracy of prognosis estimation made by physicians has previously been investigated mainly among intensive care physicians and oncologists.</p><p><b>Objective</b> To ascertain the accuracy of prognosis prediction made by internists for septic patients on admission to IM departments.</p><p><b>Methods</b> Physicians were asked to estimate the prognosis of every patient identified to have sepsis on admission. Their intuitive assessment of prognosis was incorporated into the patients’ electronic medical record. Survival follow-up was recorded until death or for at least 2 years. Later we compared survival with physicians’ prognosis estimations.</p><p><b>Results</b> Prognosis estimation was recorded for 1,073 consecutive septic patients admitted throughout the years 2008–2009 to IM departments. The mean age of patients was 74.7 ± 16.1 years. A total of 42.4% were suspected to have pneumonia, and 65.4% died during a mean follow-up time of 661.1 ± 612.3 days. Almost half of the patients classified to have good prognosis survived compared to 14.9% and 4.9% of those with intermediate and bad prognosis estimation, respectively (P < 0.001).</p><p><b>Conclusion</b> Internists can discriminate well between septic patients with good, intermediate, and bad prognosis.</p><p></p><p>Key Messages</p><p></p><p>Many patients suffering from sepsis are treated at general medical departments.</p><p></p><p></p><p>Good estimation of the severity of disease upon admission is critical for decision-making regarding treatment.</p><p></p><p></p><p>Internists including junior staff could discriminate well between patients with different degrees of disease severity of sepsis.</p><p></p><p></p><p></p></div

Overall survival hazard ratio, multivariate Cox regression analysis.

<p>* At any stage of the disease treatment</p><p>Overall survival hazard ratio, multivariate Cox regression analysis.</p

Drugs administered in parallel with second-line anti Her-2 therapy.

<p>Drugs administered in parallel with second-line anti Her-2 therapy.</p

Baseline demographics and patient clinical characteristics.

<p>^at-test</p><p>^bMann-Whitney test</p><p>^cchi-square test</p><p>*WBR- Whole Brain Irradiation</p><p>Baseline demographics and patient clinical characteristics.</p

Multivariable Regression Analysis for Poor Glycemic Control (HbA1c>75 mmol/mol [9.0%]).

<p>*SES  =  socio-economic status.</p><p>**mo  =  months.</p><p>Multivariable Regression Analysis for Poor Glycemic Control (HbA1c>75 mmol/mol [9.0%]).</p

Patient exclusions flow chart.

<p>The figure shows the process for arriving at the final sample size. After all exclusion criteria were applied, a final study population of 228,846 patients with diabetes who had a prescription for oral anti-glycemic medications and an HbA1c test performed was yielded.</p

Percent of study population with poor adherence and poor control by disease duration and age.

<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108145#pone-0108145-g002" target="_blank">Figure 2a</a> shows that there is a positive correlation between the duration of having diabetes, and the level of poor control over the disease. In other words, the longer a patient has diabetes, the poorer his control may be. Furthermore, as the duration of having diabetes increases, poor adherence to medication decreases; so medication adherence is stronger among those who have had diabetes longer. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108145#pone-0108145-g002" target="_blank">Figure 2b</a> demonstrates that as the age group of patients with diabetes increases, both poor control of the disease and poor medication adherence decreases. In other words, control and adherence are stronger among the older age groups.</p

Demographic and clinical characteristics according to glucose control.

<p>*mo  =  months.</p><p>Demographic and clinical characteristics according to glucose control.</p