Frontiers in medicine · 2026
The vasoactive-age adjusted sepsis-induced coagulopathy score predicts 28-day new-onset multiple organ dysfunction syndrome in patients with sepsis: a single-centre retrospective cohort study.
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Cao Ke-Jun, Ge Jia-Qi, Fang Hong-Zhi
Аннотация
BACKGROUND: Early identification of sepsis patients at high risk of multiple organ dysfunction syndrome (MODS) remains challenging. The Sepsis-Induced Coagulopathy (SIC) score does not incorporate age or vasopressor use, both strongly associated with organ failure progression. The Vasoactive-Age adjusted SIC (VAS) score integrates these dimensions, but its predictive value for new-onset MODS has not been systematically evaluated.
METHODS: This single-centre retrospective cohort study enrolled 495 adult sepsis patients (Sepsis-3.0 criteria) admitted between January 2019 and June 2023. Baseline VAS, SIC, Sequential Organ Failure Assessment (SOFA), 24-h worst SOFA (SOFA-2), Acute Physiology and Chronic Health Evaluation II (APACHE II), and quick SOFA (qSOFA) scores were calculated. The primary outcome was 28-day new-onset MODS. Predictive performance was compared using the area under the receiver operating characteristic curve (AUC) and the DeLong method. Cumulative incidence was estimated with Fine-Gray competing-risk models. Independent predictors were identified by multivariable Cox regression. Net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis quantified incremental value. A nomogram was internally validated by 1,000-bootstrap resampling.
RESULTS: New-onset MODS occurred in 148 patients (29.9%). The VAS score yielded an AUC of 0.777 [95% confidence interval (CI) 0.755-0.841], significantly higher than SIC (0.708, p < 0.001) and qSOFA (0.671, p < 0.001), and comparable to SOFA (0.757, p = 0.083). The optimal cut-off of VAS ≥ 4 yielded 76.4% sensitivity and 73.2% specificity. After multivariable adjustment, VAS ≥ 4 remained independently predictive of MODS [hazard ratio (HR) 3.42, 95% CI 2.31-5.07, p < 0.001], with significant interactions for age (p = 0.024), septic shock (p = 0.038), and SIC status (p = 0.041). Adding lactate, procalcitonin, and N-terminal pro-B-type natriuretic peptide increased the AUC to 0.853 (NRI = 0.124, p = 0.012; IDI = 0.086, p = 0.021). A dynamic VAS increase (ΔVAS>0) over 48 h was independently associated with a 4.78-fold higher MODS risk (p < 0.001). The internally validated nomogram achieved a corrected C-index of 0.821.
CONCLUSION: The VAS score is a simple bedside tool that independently predicts 28-day new-onset MODS in sepsis, outperforming the SIC score and matching SOFA with fewer parameters. Combination with circulating biomarkers and dynamic ΔVAS monitoring provides additional prognostic value and supports its integration into early sepsis risk stratification.
METHODS: This single-centre retrospective cohort study enrolled 495 adult sepsis patients (Sepsis-3.0 criteria) admitted between January 2019 and June 2023. Baseline VAS, SIC, Sequential Organ Failure Assessment (SOFA), 24-h worst SOFA (SOFA-2), Acute Physiology and Chronic Health Evaluation II (APACHE II), and quick SOFA (qSOFA) scores were calculated. The primary outcome was 28-day new-onset MODS. Predictive performance was compared using the area under the receiver operating characteristic curve (AUC) and the DeLong method. Cumulative incidence was estimated with Fine-Gray competing-risk models. Independent predictors were identified by multivariable Cox regression. Net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis quantified incremental value. A nomogram was internally validated by 1,000-bootstrap resampling.
RESULTS: New-onset MODS occurred in 148 patients (29.9%). The VAS score yielded an AUC of 0.777 [95% confidence interval (CI) 0.755-0.841], significantly higher than SIC (0.708, p < 0.001) and qSOFA (0.671, p < 0.001), and comparable to SOFA (0.757, p = 0.083). The optimal cut-off of VAS ≥ 4 yielded 76.4% sensitivity and 73.2% specificity. After multivariable adjustment, VAS ≥ 4 remained independently predictive of MODS [hazard ratio (HR) 3.42, 95% CI 2.31-5.07, p < 0.001], with significant interactions for age (p = 0.024), septic shock (p = 0.038), and SIC status (p = 0.041). Adding lactate, procalcitonin, and N-terminal pro-B-type natriuretic peptide increased the AUC to 0.853 (NRI = 0.124, p = 0.012; IDI = 0.086, p = 0.021). A dynamic VAS increase (ΔVAS>0) over 48 h was independently associated with a 4.78-fold higher MODS risk (p < 0.001). The internally validated nomogram achieved a corrected C-index of 0.821.
CONCLUSION: The VAS score is a simple bedside tool that independently predicts 28-day new-onset MODS in sepsis, outperforming the SIC score and matching SOFA with fewer parameters. Combination with circulating biomarkers and dynamic ΔVAS monitoring provides additional prognostic value and supports its integration into early sepsis risk stratification.