Phoenix Cardiovascular Score

Generate the cardiovascular organ system dysfunction score as part of the diagnostic Phoenix Sepsis Criteria.

Usage

phoenix_cardiovascular(
  vasoactives = NA_integer_,
  lactate = NA_real_,
  age = NA_real_,
  map = NA_real_,
  data = parent.frame(),
  ...
)

Arguments

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
age: numeric vector age in months
map: numeric vector, mean arterial pressure in mmHg
data: a list, data.frame, or environment containing the input vectors
...: pass through

Value

a integer vector with values 0, 1, 2, 3, 4, 5, or 6.

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

There where six systemic vasoactive medications considered when the Phoenix criteria was developed: dobutamine, dopamine, epinephrine, milrinone, norepinephrine, and vasopressin.

During development, the values used for map were taken preferentially from arterial measurement, then cuff measures, and provided values before approximating the map from blood pressure values via DBP + 1/3 (SBP - DBP), where DBP is the diastolic blood pressure and SBP is the systolic blood pressure.

Phoenix Cardiovascular Scoring

The Phoenix Cardiovascular score ranges from 0 to 6 points; 0, 1, or 2 points for each of systolic vasoactive medications, lactate, and MAP.

Systemic Vasoactive Medications

0 medications	0 points
1 medication	1 point
2 or more medications	2 points

Lactate

[0, 5)	0 points
[5, 11)	1 point
[11, Inf)	2 points

MAP

Age in [0, 1) months
	[31, Inf) mmHg	0 points
	[17, 31) mmHg	1 point
	[0, 17) mmHg	2 points
Age in [1, 12) months
	[39, Inf) mmHg	0 points
	[25, 39) mmHg	1 point
	[0, 25) mmHg	2 points
Age in [12, 24) months
	[44, Inf) mmHg	0 points
	[31, 44) mmHg	1 point
	[0, 31) mmHg	2 points
Age in [24, 60) months
	[45, Inf) mmHg	0 points
	[32, 45) mmHg	1 point
	[0, 32) mmHg	2 points
Age in [60, 144) months
	[49, Inf) mmHg	0 points
	[36, 49) mmHg	1 point
	[0, 36) mmHg	2 points
Age in [144, 216] months
	[52, Inf) mmHg	0 points
	[38, 52) mmHg	1 point
	[0, 38) mmHg	2 points

References

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

Examples


# using the example sepsis data set
phoenix_cardiovascular(
   vasoactives = dobutamine + dopamine + epinephrine + milrinone + norepinephrine + vasopressin,
   lactate = lactate,
   age = age,
   map = dbp + (sbp - dbp)/3,
   data = sepsis
)
#>  [1] 2 2 1 0 0 1 4 0 3 0 3 0 0 2 3 2 2 2 2 1

# example data set to get all the possible scores
DF <-
  expand.grid(vasos = c(NA, 0:6),
              lactate = c(NA, 3.2, 5, 7.8, 11, 14),
              age = c(NA, 0.4, 1, 3, 12, 18, 24, 45, 60, 61, 144, 145),
              map = c(NA, 16:52))
DF$card <- phoenix_cardiovascular(vasos, lactate, age, map, DF)
head(DF)
#>   vasos lactate age map card
#> 1    NA      NA  NA  NA    0
#> 2     0      NA  NA  NA    0
#> 3     1      NA  NA  NA    1
#> 4     2      NA  NA  NA    2
#> 5     3      NA  NA  NA    2
#> 6     4      NA  NA  NA    2

# what if lactate is unknown for all records? - set the value either in the
# data object or the arguement value to NA
DF2 <-
  expand.grid(vasos = c(NA, 0:6),
              age = c(NA, 0.4, 1, 3, 12, 18, 24, 45, 60, 61, 144, 145),
              map = c(NA, 16:52))
DF2$card <- phoenix_cardiovascular(vasos, lactate = NA, age, map, DF2)

DF3 <-
  expand.grid(vasos = c(NA, 0:6),
              lactate = NA,
              age = c(NA, 0.4, 1, 3, 12, 18, 24, 45, 60, 61, 144, 145),
              map = c(NA, 16:52))
DF3$card <- phoenix_cardiovascular(vasos, lactate, age, map, DF3)

identical(DF2$card, DF3$card)
#> [1] TRUE