phoenix {phoenix}

The Phoenix Sepsis Score

Description

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

Details

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

Value

A data.frame with seven columns:

1. phoenix_respiratory_score

2. phoenix_cardiovascular_score

3. phoenix_coagulation_score

4. phoenix_neurologic_score

5. phoenix_sepsis_score

6. phoenix_sepsis An integer vector, 0 = not septic, 1 = septic (score greater or equal to 2)

7. 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.

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
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)