Risk Stratification Using the Tracheostomy Early Prediction Score and the Association Between Early Tracheostomy and Mortality in Sepsis

BACKGROUND: The impact of tracheostomy timing on mortality in mechanically ventilated patients is inconclusive, partly because identifying patients who require a tracheostomy is challenging. This study aimed to assess the association between tracheostomy timing and mortality using risk stratification based on the Sepsis Tracheostomy Early Prediction (STeP) score. METHODS: This retrospective cohort study used data from a Japanese Intensive Care Patient Database. Subjects with sepsis who required mechanical ventilation and underwent tracheostomy were included and classified into low- (0-2), moderate- (3-6), and high-risk (≥7) groups based on the STeP score. Early (≤7 d) and late (>7 d) tracheostomy were compared within each group using 1:1 propensity score matching (PSM). Sensitivity analyses were performed using a generalized linear mixed-effects model with hospitals as a random effect to account for between-hospital variability and the inverse probability of treatment weighting. The primary outcome was the in-hospital mortality rate. RESULTS: After 1:1 PSM matching, 52, 114, and 404 matched pairs were obtained in the low-, moderate-, and high-risk groups, respectively. In the high-risk group, early tracheostomy was associated with a significantly lower mortality rate than late tracheostomy (28.0% vs 36.1%; odds ratio, 0.67, 95% CI 0.49-0.92). No significant differences were observed between low- and moderate-risk groups. These findings were consistent across sensitivity analyses. CONCLUSIONS: Early tracheostomy was associated with lower mortality in high-risk subjects as identified by the STeP score, whereas no such association was observed in low- and moderate-risk patients.