The Phoenix 8 Sepsis Score

The extended Phoenix criteria using a total eight organ systems. This is intended mostly for research as an extension of the Phoenix Sepsis Criteria which is based on four organ systems.

Usage

phoenix8(
  pf_ratio,
  sf_ratio,
  imv,
  other_respiratory_support,
  vasoactives,
  lactate,
  map,
  platelets,
  inr,
  d_dimer,
  fibrinogen,
  gcs,
  fixed_pupils,
  glucose,
  anc,
  alc,
  creatinine,
  bilirubin,
  alt,
  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

glucose

numeric vector; blood glucose measured in mg/dL

anc

absolute neutrophil count; a numeric vector; units of 1,000 cells per cubic millimeter

alc

absolute lymphocyte count; a numeric vector; units of 1,000 cells per cubic millimeter

creatinine

numeric vector; units of mg/dL

bilirubin

numeric vector; units of mg/dL

alt

alanine aminotransferase; a numeric vector; units of IU/L

age

numeric vector age in months

data

a list, data.frame, or environment containing the input vectors

...

pass through

Value

a data.frame with 12 integer columns.

1. phoenix_respiratory_score

2. phoenix_cardiovascular_score

3. phoenix_coagulation_score

4. phoenix_neurologic_score

5. phoenix_sepsis_score

6. phoenix_sepsis 0 = not septic; 1 = septic (phoenix_sepsis_score greater or equal 2)

7. phoenix_septic_shock 0 = no septic shock; 1 = septic shock (sepsis with cardiovascular dysfunction)

8. phoenix_endocrine_score

9. phoenix_immunologic_score

10. phoenix_renal_score

11. phoenix_hepatic_score

12. phoenix8_sepsis_score

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 Phoenix Sepsis Criteria is based on the score form respiratory, cardiovascular, coagulation, and neurologic. Phoenix 8 uses these four an endocrine, immunologic, renal, and hepatic. Details on the scoring for each of the eight component organ systems are found in the respective manual files.

References

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

See also

• phoenix for generating the diagnostic Phoenix Sepsis score based on the four organ systems:

  • phoenix_cardiovascular,

  • phoenix_coagulation,

  • phoenix_neurologic,

  • phoenix_respiratory,

• phoenix8 for generating the diagnostic Phoenix 8 Sepsis criteria based on the four organ systems noted above and

  • phoenix_endocrine,

  • phoenix_immunologic,

  • phoenix_renal,

  • phoenix_hepatic,

vignette('phoenix') for more details and examples.

Examples

# Using the example sepsis data set, read more details in the vignette
phoenix8_scores <-
  phoenix8(
    # 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, # Also used in the renal assessment.
      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"),
    # endocrine
      glucose = glucose,
    # immunologic
      anc = anc,
      alc = alc,
    # renal
      creatinine = creatinine,
      # no need to specify age again
    # hepatic
      bilirubin = bilirubin,
      alt = alt,
    data = sepsis
  )

str(phoenix8_scores)
#> 'data.frame':	20 obs. of  12 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 ...
#>  $ phoenix_endocrine_score     : int  0 0 0 0 0 0 0 0 1 0 ...
#>  $ phoenix_immunologic_score   : int  0 1 1 1 0 1 0 1 1 1 ...
#>  $ phoenix_renal_score         : int  1 0 0 0 0 1 1 0 1 0 ...
#>  $ phoenix_hepatic_score       : int  0 0 1 1 0 0 1 0 1 0 ...
#>  $ phoenix8_sepsis_score       : int  4 8 8 3 0 9 11 2 12 5 ...