The Diagnostic Value of H Formula to Predict Mortality in Hospitalized Patients with Infectious Diseases

Ali Akbar Heydari, Khosro Mohammadi, Saied Akhlaghi, Arash Arianpoor

Research Center for Infection Control & Hand Hygiene, Mashhad University of Medical Sciences, Mashhad, Iran.

DOI: 10.4236/aid.2014.42014                

Abstract

The ability to identify patients with risk of mortality in the initial stages allows us to introduce a more aggressive treatment in order to improve patients’ survival. In this study, we used systemic inflammatory response syndrome (SIRS) criteria, respiratory and heart rate per minute, and consciousness level [(Glasgow coma scale (GCS)] to develop a formula to predict death in patients admitted to the Infectious Diseases ward of Imam Reza hospital. Methods: This descriptive study was a cross sectional study done in the Infectious Diseases ward of Imam Reza hospital, Mashhad University of Medical Sciences, Iran. Alive and dead patients between the dates September 1, 2006 to September 1, 2007 were studied. In this study, data such as past medical history, prescribed drugs and their administration by nursing and medical staff was extracted from patients’ files. Also, the time of death, the first vital signs recorded in the hospital and the formula H = (PR + RR) - GCS (respiratory rate per minute plus heart rate per minute minus Glasgow coma scale (GCS)) was calculated for both alive and dead patients. Data was analyzed by SPSS software. Mann-Whitney test, Roc Curve, and logistic regression model were used for data analysis. Results: The total number of admitted patients was 1007 of whom 90 (10.82%) died. One patient was excluded from the study. Out of 90 dead patients, 51 (56.6%) were male and 39 (43.3%) were female. There was no significant difference between the two groups regarding the gender (P > 0.05). The mean age of the study group (deceased) was 59 ± 21 and the mean age of the control group (alive) was 58 ± 21. The Mann-Whitney test showed that the result of H Formula was significantly different between the two groups, (126 ± 26 for the study group and 111 ± 22 for the control group). The cutoff for H Formula was equal to 112.5. Negative and positive predictive values, specificity and sensitivity were 0.85, 0.35, 0.57, and 0.70 respectively. Logistic regression results show that the H index contents independently affected the mortality of infected patients. Conclusion: With regard to the importance of measuring vital signs in diagnosis and determining the mortality in patients with infectious disease, the H (Heydari) formula can be valuable for evaluation and determination of mortality risk and consequently, early intervention. Patients with severe tachycardia, severe tachypnea and altered mental status that cannot be properly and quickly improved within 2 hours after admission via hydration and other measures are at higher risk of mortality.

Keywords

Mortality, Prediction, Infectious Disease, H Formula, Vital Signs

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Zarei, M.-R., Dianat, S., Eslami, V., Harirchi, I., Boddouhi, N., Zandieh, A., et al. (2011) Factors Associated with Mortality in Adult Hospitalized Burn Patients in Tehran. Ulus Travma Acil Cerrahi Derg, 17, 61-65. http://dx.doi.org/10.5505/tjtes.2011.22129
[2]	Bone, R.C., Balk, R.A., Cerra, F.B., Dellinger, R.P., Fein, A.M., Knaus, W.A., et al. (1992) Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest Journal, 101, 1644-1655. http://dx.doi.org/10.1378/chest.101.6.1644
[3]	Morrell, M.R., Micek, S.T. and Kollef, M.H. (2009) The Management of Severe Sepsis and Septic Shock. Infectious Disease Clinics of North America, 23, 485-501. http://dx.doi.org/10.1016/j.idc.2009.04.002
[4]	Nguyen, H.B., Rivers, E.P., Abrahamian, F.M., Moran, G.J., Abraham, E., Trzeciak, S., et al. (2006) Severe Sepsis and Septic Shock: Review of the Literature and Emergency Department Management Guidelines. Annals of Emergency Medicine, 48, 54.
[5]	Levy, M.M., Fink, M.P., Marshall, J.C., Abraham, E., Angus, D., Cook, D., et al. (2003) 2001 SCCM/ESICM/ACCP/ ATS/SIS International Sepsis Definitions Conference. Intensive Care Medicine, 29, 530-538. http://dx.doi.org/10.1007/s00134-003-1662-x
[6]	Cornbleet, P.J. (2002) Clinical Utility of the Band Count. Clinics in Laboratory Medicine, 22, 101-136. http://dx.doi.org/10.1016/S0272-2712(03)00069-6
[7]	Sankoff, J.D., Goyal, M., Gaieski, D.F., Deitch, K., Davis, C.B., Sabel, A.L., et al. (2008) Validation of the Mortality in Emergency Department Sepsis (MEDS) Score in Patients with the Systemic Inflammatory Response Syndrome (SIRS). Critical Care Medicine, 36, 421-426. http://dx.doi.org/10.1097/01.CCM.0B013E3181611F6A0
[8]	Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., et al. (2001) Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. New England Journal of Medicine, 345, 1368-1377. http://dx.doi.org/10.1056/NEJMoa010307
[9]	Annane, D., Sebille, V., Charpentier, C., Bollaert, P.-E., Francois, B., Korach, J.-M., et al. (2002) Effect of Treatment with Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients with Septic Shock. JAMA, 288, 862-871. http://dx.doi.org/10.1001/jama.288.7.862
[10]	Van Den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., et al. (2001) Intensive Insulin Therapy in Critically Ill Patients. New England Journal of Medicine, 345, 1359-1367. http://dx.doi.org/10.1056/NEJMoa011300
[11]	Bernard, G.R., Vincent, J.-L., Laterre, P.-F., LaRosa, S.P., Dhainaut, J.-F., Lopez-Rodriguez, A., et al. (2001) Efficacy and Safety of Recombinant Human Activated Protein C for Severe Sepsis. New England Journal of Medicine, 344, 699-709. http://dx.doi.org/10.1056/NEJM200103083441001
[12]	Talan, D.A., Moran, G.J. and Abrahamian, F.M. (2008) Severe Sepsis and Septic Shock in the Emergency Department. Infectious Disease Clinics of North America, 22, 1-31. http://dx.doi.org/10.1016/j.idc.2007.09.005
[13]	Griffin, M.P. and Moorman, J.R. (2001) Toward the Early Diagnosis of Neonatal Sepsis and Sepsis-Like Illness Using Novel Heart Rate Analysis. Pediatrics, 107, 97-104. http://dx.doi.org/10.1016/j.idc.2007.09.005
[14]	Griffin, M.P., O’Shea, T.M., Bissonette, E.A., Harrell, F.E., Lake, D.E. and Moorman, J.R. (2003) Abnormal Heart Rate Characteristics Preceding Neonatal Sepsis and Sepsis-Like Illness. Pediatric Research, 53, 920-926. http://dx.doi.org/10.1203/01.PDR.0000064904.05313.D2
[15]	Annane, D., Trabold, F., Sharshar, T., Jarrin, I., Blanc, A.S., Raphael, J.C., et al. (1999) Inappropriate Sympathetic Activation at Onset of Septic Shock: A Spectral Analysis Approach. American Journal of Respiratory and Critical Care Medicine, 160, 458-465. http://dx.doi.org/10.1164/ajrccm.160.2.9810073
[16]	Chen, W.L., Chen, J.H., Huang, C.C., Kuo, C.D., Huang, C.I. and Lee, L.S. (2008) Heart Rate Variability Measures as Predictors of In-Hospital Mortality in ED Patients with Sepsis. The American Journal of Emergency Medicine, 26, 395-401. http://dx.doi.org/10.1016/j.ajem.2007.06.016
[17]	Seely, A.J. and Christou, N.V. (2000) Multiple Organ Dysfunction Syndrome: Exploring the Paradigm of Complex Nonlinear Systems. Critical Care Medicine, 28, 2193-2200. http://dx.doi.org/10.1097/00003246-200007000-00003
[18]	Godin, P.J. and Buchman, T.G. (1996) Uncoupling of Biological Oscillators: A Complementary Hypothesis Concerning the Pathogenesis of Multiple Organ Dysfunction Syndrome. Critical Care Medicine, 24, 1107-1116. http://dx.doi.org/10.1097/00003246-199607000-00008
[19]	Rangel-Frausto, M.S., Pittet, D., Costigan, M., Hwang, T., Davis, C.S. and Wenzel, R.P. (1995) The Natural History of the Systemic Inflammatory Response Syndrome (SIRS): A Prospective Study. JAMA, 273, 117-123. http://dx.doi.org/10.1001/jama.1995.03520260039030
[20]	McCabe, W.R. and Jackson, G.G. (1962) Gram-Negative Bacteremia: I. Etiology and Ecology. JAMA Internal Medicine, 110, 847-855. http://dx.doi.org/10.1001/archinte.1962.03620240029006
[21]	Bates, D.W., Pruess, K.E. and Lee, T.H. (1995) How Bad Are Bacteremia and Sepsis? Outcomes in a Cohort with Suspected Bacteremia. JAMA Internal Medicine, 155, 593-598. http://dx.doi.org/10.1001/archinte.1995.00430060050006
[22]	Perl, T.M., Dvorak, L., Hwang, T. and Wenzel, R.P. (1995) Long-Term Survival and Function after Suspected GramNegative Sepsis. JAMA, 274, 338-345. http://dx.doi.org/10.1001/jama.1995.03530040066043
[23]	Sharshar, T., Hopkinson, N.S., Orlikowski, D. and Annane, D. (2005) Science Review: The Brain in Sepsis-Culprit and Victim. Critical Care, 9, 37-44. http://dx.doi.org/10.1186/cc2951
[24]	Friedland, J.S., Porter, J.C., Daryanani, S., Bland, J.M., Screaton, N.J., Vesely, M.J., et al. (1996) Plasma Proinflammatory Cytokine Concentrations, Acute Physiology and Chronic Health Evaluation (APACHE) III Scores and Survival in Patients in an Intensive Care Unit. Critical Care Medicine, 24, 1775-1781. http://dx.doi.org/10.1097/00003246-199611000-00003
[25]	Vincent, J.L., De Mendonca, A., Cantraine, F., Moreno, R., Takala, J., Suter, P.M., Sprung, C.L., Colardyn, F. and Blecher, S. (1998) Use of the SOFA Score to Assess the Incidence of Organ Dysfunction/Failure in Intensive Care Units: Results of a Multicenter, Prospective Study. Critical Care Medicine, 26, 1793-1800. http://dx.doi.org/10.1097/00003246-199811000-00016
[26]	Shapiro, N.I., Wolfe, R.E., Moore, R.B., Smith, E., Burdick, E. and Bates, D.W. (2003) Mortality in Emergency Department Sepsis (MEDS) Score: A Prospectively Derived and Validated Clinical Prediction Rule. Critical Care Medicine, 31, 670-675. http://dx.doi.org/10.1097/01.CCM.0000054867.01688.D1
[27]	Jabalameli, M. (2012) Evaluating the Correlation of Systemic Inflammatory Response Syndrome with Mortality and Morbidity in Critically Ill Obstetric Patients in ICU. Qom University of Medical Sciences Journal, 4, 37-41.
[28]	Heydari, A. and Ghabouli, M. (2007) The Relationship between Severity of the Systemic Inflammatory Response Syndrome (SIRS) and Its Etiology and Outcome. Medical Journal of Mashhad University of Medical Sciences, 50, 321-326.