468 - nSOFA for Sepsis: Mortality Prediction for All NICU Patients with Sepsis

The neonatal sequential organ failure assessment (nSOFA) score is an operational definition of life-threatening organ dysfunction applicable to neonates with a score range from 0 (best) to 15 (worst). Automated nSOFA scoring can be integrated into the electronic health record system and increasing nSOFA scores indicate higher mortality risk. The nSOFA to predict late onset sepsis mortality was validated in a multicenter study of < 32 week neonates. However, the utility of the nSOFA for sepsis-related mortality is unclear for more mature neonates. Recently, we showed plasma IL8 is significantly elevated in neonates who die after sepsis.  


Objective:

Assess the utility of nSOFA for neonates with sepsis regardless of GA, and assess the utility of adding IL8 to the nSOFA scoring system and compare the new score to the existing one


Design/Methods:

Secondary retrospective analysis of a prospective study conducted in two NICUs in Cincinnati, Ohio from June 2020 to December 2021 that used serum biomarkers to derive a mortality prediction tool called nPERSEVERE. This cohort included preterm and term neonates, with and without congenital anomalies. nSOFA scores were calculated at 0, +6h, +12h, +24h, +48h time points referent to the start of blood culture and parenteral antimicrobial treatment. Sepsis was defined (clinically suspicion of infection) and continuation of antibiotics for >48 hours. Mortality was defined as death while receiving antibiotic therapy for the sepsis event when biomarkers were measured. Neonates who experienced late death after treatment was completed were excluded. Statistical analyses were performed using GraphPad Prism v9.0.


Results:

52 neonates with sepsis (n = 39 bacteremia, n = 25 >32 weeks) were included. Compared to survivors, non-survivors (n = 5) had higher nSOFA scores at every time point in the first 48 hours of sepsis (Fig 1 a). At the time of evaluation, nSOFA had an AUC of 0.81 (95% CI 0.63-0.99), p 0.025. The addition of IL8 to the nSOFA score improved mortality prediction. A cutoff nSOFA score of 4 at the time of sepsis evaluation was 80% sensitive, 69% specific, with a +LR of 2.4 for mortality. Adding IL8 scoring to nSOFA (Table 1) (Fig 1 b) and having a score cutoff of 10 enhanced the specificity and +LR while retaining a sensitivity of 80% (Table 2).


Conclusion(s):

Although validation in a large prospective cohort is needed to confirm our findings, these data suggest utility for the nSOFA to predict sepsis-associated mortality in larger more mature neonates admitted to the NICU. The addition of IL8 could further enhance the predictive utility of the nSOFA.