The Phoenix Sepsis Score

The diagnostic Phoenix Sepsis Criteria based on four organ dysfunction scores, respiratory, cardiovascular, coagulation, and neurologic. A score of 2 or more indicates sepsis.

Usage

phoenix(
  pf_ratio,
  sf_ratio,
  imv,
  other_respiratory_support,
  vasoactives,
  lactate,
  map,
  platelets,
  inr,
  d_dimer,
  fibrinogen,
  gcs,
  fixed_pupils,
  age,
  data = parent.frame(),
  ...
)

Arguments

pf_ratio: numeric vector for the PaO2/FiO2 ratio; PaO2 = arterial oxygen pressure; FiO2 = fraction of inspired oxygen; PaO2 is measured in mmHg and FiO2 is from 0.21 (room air) to 1.00.
sf_ratio: numeric vector for the SpO2/FiO2 ratio; SpO2 = oxygen saturation, measured in a percent; ratio for 92% oxygen saturation on room air is 92/0.21 = 438.0952.
imv: invasive mechanical ventilation; numeric or integer vector, (0 = not intubated; 1 = intubated)
other_respiratory_support: other respiratory support; numeric or integer vector, (0 = no support; 1 = support)
vasoactives: an integer vector, the number of systemic vasoactive medications being administered to the patient. Six vasoactive medications are considered: dobutamine, dopamine, epinephrine, milrinone, norepinephrine, vasopressin.
lactate: numeric vector with the lactate value in mmol/L
map: numeric vector, mean arterial pressure in mmHg
platelets: numeric vector for platelets counts in units of 1,000/uL (thousand per microliter)
inr: numeric vector for the international normalised ratio blood test
d_dimer: numeric vector for D-Dimer, units of mg/L FEU
fibrinogen: numeric vector units of mg/dL
gcs: integer vector; total Glasgow Comma Score
fixed_pupils: integer vector; 1 = bilaterally fixed pupil, 0 = otherwise
age: numeric vector age in months
data: a list, data.frame, or environment containing the input vectors
...: pass through

Value

A data.frame with seven columns:

phoenix_respiratory_score
phoenix_cardiovascular_score
phoenix_coagulation_score
phoenix_neurologic_score
phoenix_sepsis_score
phoenix_sepsis An integer vector, 0 = not septic, 1 = septic (score greater or equal to 2)
phoenix_septic_shock An integer vector, 0 = not septic shock, 1 = septic shock (score greater or equal 2 and cardiovascular dysfunction)

As with all other Phoenix organ system scores, missing values in the data set will map to a score of zero - this is consistent with the development of the criteria.

Details

The details of each of the four component scores are found in there respective help files.

References

See reference details in phoenix-package or by calling citation('phoenix').

Examples


# Using the example sepsis data set, read more details in the vignette
phoenix_scores <-
  phoenix(
    # respiratory
      pf_ratio = pao2 / fio2,
      sf_ratio = ifelse(spo2 <= 97, spo2 / fio2, NA_real_),
      imv = vent,
      other_respiratory_support = as.integer(fio2 > 0.21),
    # cardiovascular
      vasoactives = dobutamine + dopamine + epinephrine + milrinone + norepinephrine + vasopressin,
      lactate = lactate,
      age = age,
      map = dbp + (sbp - dbp)/3,
    # coagulation
      platelets = platelets,
      inr = inr,
      d_dimer = d_dimer,
      fibrinogen = fibrinogen,
    # neurologic
      gcs = gcs_total,
      fixed_pupils = as.integer(pupil == "both-fixed"),
    data = sepsis
  )

str(phoenix_scores)
#> 'data.frame':	20 obs. of  7 variables:
#>  $ phoenix_respiratory_score   : int  0 3 3 0 0 3 3 0 3 3 ...
#>  $ phoenix_cardiovascular_score: int  2 2 1 0 0 1 4 0 3 0 ...
#>  $ phoenix_coagulation_score   : int  1 1 2 1 0 2 2 1 1 0 ...
#>  $ phoenix_neurologic_score    : int  0 1 0 0 0 1 0 0 1 1 ...
#>  $ phoenix_sepsis_score        : int  3 7 6 1 0 7 9 1 8 4 ...
#>  $ phoenix_sepsis              : int  1 1 1 0 0 1 1 0 1 1 ...
#>  $ phoenix_septic_shock        : int  1 1 1 0 0 1 1 0 1 0 ...