The receiver operating characteristic often (ROC) curves for the initial StO2, ischemic slope, recovery slope and serum lactate measurements as predictors of in-hospital mortality are shown.Organ dysfunction at 24 hoursNext, we assessed the StO2 parameters for their ability to predict organ dysfunction, defined a priori as SOFA score �� 2 at 24 hours. The initial and occlusion StO2 metrics, as well as serum lactate, SBP and age, were significantly abnormal in patients with SOFA scores �� 2 at 24 hours compared to those with SOFA scores < 2 (Tables (Tables44 and and5).5). The StO2 occlusion slope did not show a statistically significant difference between the groups. The AUC for the groups were initial slope, 0.61 (0.52 to 0.70); ischemic slope, 0.57 (0.48 to 0.66); recovery slope 0.68 (0.59 to 0.

76); and lactate slope 0.69 (0.61 to 0.78). The ROCs are shown in Figure Figure6.6. We also examined the correlation between the NIRS parameters at initial presentation and the total SOFA score and found a correlation between StO2 initial slope (Spearman’s �� correlation coefficient = -0.18; P < 0.04), occlusion slope (Spearman's �� correlation coefficient = 0.21; P < 0.02) and recovery slope (Spearman's �� correlation coefficient = -0.35; P < 0.001).Table 4Serum lactate and systolic blood pressure- and near-infrared spectroscopy-derived parameters stratified by Sequential Organ Failure Assessment score at 24 hours for all groupsaTable 5Results of multivariate logistic regression modeling for the outcomes of Sequential Organ Failure Assessment score �� 2 at 24 hours and in-hospital mortality in all groupsaFigure 6Receiver operating characteristic curves for Sequential Organ Failure Assessment scores �� 2.

The receiver operating characteristic (ROC) curves for the initial tissue oxygen saturation, ischemic slope, recovery slope and serum lactate measurements …Sensitivity analysisWe chose to use the entire study population and included the uninfected control population in our analyses to assess mortality outcomes, as well as organ dysfunction at 24 hours, to take advantage of our full data set. However, one could argue against this approach and make the case for including only patients who fulfilled the minimum inclusion criteria for the definition of sepsis. Thus, we performed a subsequent sensitivity analysis in which we limited the analysis to the 118 patients enrolled from the SEPSIS and SHOCK groups.

The results of this analysis were very similar to those of our primary analyses (Additional file 1 online data supplement).DiscussionIn this multicenter study of ED patients who presented across the spectrum of sepsis illness severity, we have demonstrated that there is a potential role for noninvasive NIRS technology in patient Brefeldin_A assessment and risk stratification.