Comparison of Analytic Approaches for Determining Variables - A Case Study in Predicting the Likelihood of Sepsis

Sepsis is a significant cause of mortality and morbidity and is often associated with increased hospital resource utilization, prolonged intensive care unit (ICU) and hospital stay. The economic burden associated with sepsis is severe. With advances in medicine, there are now aggressive goal oriented treatments that can be used to help these patients. If we were able to predict which patients may be at risk for sepsis we could start treatment early and potentially reduce the risk of mortality and morbidity. Analytic methods currently used in clinical research to determine the risk of a patient developing sepsis may be further enhanced by using multi-modal analytic methods that together could be used to provide greater precision. Researchers commonly use univariate and multivariate regressions to develop predictive models. We hypothesized that such models could be enhanced by using multi-modal analytic methods that together could be used to provide greater precision. In this paper, we analyze data about patients with and without sepsis using a decision tree approach. A comparison with a regression approach shows strong similarity among variables identified, though not an exact match. We compare the variables identified by the different approaches and draw conclusions about the respective predictive capabilities.

[1]  M. Levy,et al.  Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 , 2007, Intensive Care Medicine.

[2]  François Gouin,et al.  Incidence, Risk Factors, and Outcome of Severe Sepsis and Septic Shock in Adults: A Multicenter Prospective Study in Intensive Care Units , 1995 .

[3]  G. Clermont,et al.  Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care , 2001, Critical care medicine.

[4]  S. Zanotti-Cavazzoni.  A prospective, observational registry of patients with severe sepsis: The Canadian Sepsis Treatment and Response Registry , 2010 .

[5]  M. Levy,et al.  Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 , 2007, Intensive Care Medicine.

[6]  J. Helterbrand,et al.  Efficacy and safety of recombinant human activated protein C for severe sepsis , 2003 .

[7]  J. E. Carceller.  American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis , 1992, Critical care medicine.

[8]  Corinne Alberti,et al.  Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study , 2002, Intensive Care Medicine.

[9]  W. Knaus,et al.  The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. , 1991, Chest.

[10]  Jacques Letarte,et al.  Patient characteristics and costs of severe sepsis and septic shock in Quebec. , 2002, Journal of critical care.

[11]  J. L. Gall,et al.  APACHE II--a severity of disease classification system. , 1986, Critical care medicine.

[12]  D. Pittet,et al.  Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: Incidence, morbidities and outcomes in surgical ICU patients , 1995, Intensive Care Medicine.

[13]  M. Langer,et al.  The Italian SEPSIS study: Preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock , 1995, Intensive Care Medicine.

[14]  Charles Natanson,et al.  Meta-Analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose , 2004, Annals of Internal Medicine.

[15]  M. Levy,et al.  2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference , 2003, Intensive care medicine.

[16]  F Doyon,et al.  Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. , 1995, JAMA.

[17]  W. Knaus,et al.  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. , 1992, Chest.

[18]  S. Dzik.  Early goal-directed therapy in the treatment of severe sepsis and septic shock , 2002 .