Infection Probability Score (IPS):: A method to help assess the probability of infection in critically ill patients

Objective, To develop a simple score to help assess the presence or absence of infection in critically ill patients using routinely available variables. Design: Observational study of a prospective cohort of patients divided into a developmental set (n = 353) and a validation set (n = 140). Setting: Department of intensive care at an academic tertiary care center. Patients. Four hundred and ninety-three adult patients admitted to the intensive care unit for greater than or equal to24 hrs. Interventions. None. Measurements and Main Results: The presence of infection was defined using the Centers for Disease Control definitions. Body temperature, heart rate, respiratory rate, white blood cell count, and C-reactive protein concentrations were measured, and the Sequential Organ Failure Assessment score was calculated throughout the intensive care unit stay. Infection was documented in 92 of the 353 patients (26%) in the developmental set and in 41 of the 140 patients (29%) in the validation set. Univariate logistic regression was used to select significant predictors for infection. Each continuous predictor was transformed in a categorical variable using a robust locally weighted least square regression between infection and the continuous variable of interest. When more than two categories were created, the variable was separated into iso-weighted dummy variables. A multiple logistic regression model predicting infection was calculated with all the variables coded 1 or 0 allowing for relative scoring of the different predictors. The resulting Infection Probability Score consisted of six different variables and ranged from 0 to 26 points (0-2 for temperature, 0-12 for heart rate, 0-1 for respiratory rate, 0-3 for white blood cell count, 0-6 for C-reactive protein, 0-2 for Sequential Organ Failure Assessment score). Conclusions: The Infection Probability Score is a simple score that can help assess the probability of infection in critically ill patients. The variables used are simple, routinely available, and familiar to clinicians. Patients with a score <14 points have only a 10% risk of infection.