phoenix8 {phoenix}

The Phoenix 8 Sepsis Score

Description

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

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.

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.

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)