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Serial Daily Organ Failure Assessment Beyond ICU Day 5 Does Not Independently Add Precision to ICU Risk-of-Death Prediction
- Source :
- Critical Care Medicine. 45:2014-2022
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- To identify circumstances in which repeated measures of organ failure would improve mortality prediction in ICU patients.Retrospective cohort study, with external validation in a deidentified ICU database.Eleven ICUs in three university hospitals within an academic healthcare system in 2014.Adults (18 yr old or older) who satisfied the following criteria: 1) two of four systemic inflammatory response syndrome criteria plus an ordered blood culture, all within 24 hours of hospital admission; and 2) ICU admission for at least 2 calendar days, within 72 hours of emergency department presentation.NoneMEASUREMENTS AND MAIN RESULTS:: Data were collected until death, ICU discharge, or the seventh ICU day, whichever came first. The highest Sequential Organ Failure Assessment score from the ICU admission day (ICU day 1) was included in a multivariable model controlling for other covariates. The worst Sequential Organ Failure Assessment scores from the first 7 days after ICU admission were incrementally added and retained if they obtained statistical significance (p0.05). The cohort was divided into seven subcohorts to facilitate statistical comparison using the integrated discriminatory index. Of the 1,290 derivation cohort patients, 83 patients (6.4%) died in the ICU, compared with 949 of the 8,441 patients (11.2%) in the validation cohort. Incremental addition of Sequential Organ Failure Assessment data up to ICU day 5 improved the integrated discriminatory index in the validation cohort. Adding ICU day 6 or 7 Sequential Organ Failure Assessment data did not further improve model performance.Serial organ failure data improve prediction of ICU mortality, but a point exists after which further data no longer improve ICU mortality prediction of early sepsis.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Organ Dysfunction Scores
Multiple Organ Failure
health care facilities, manpower, and services
MEDLINE
Critical Care and Intensive Care Medicine
Article
Hospitals, University
03 medical and health sciences
0302 clinical medicine
Risk Factors
Humans
Medicine
Hospital Mortality
Mortality prediction
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Racial Groups
Age Factors
External validation
Repeated measures design
030208 emergency & critical care medicine
Retrospective cohort study
Length of Stay
Middle Aged
Prognosis
University hospital
Systemic Inflammatory Response Syndrome
Surgery
Intensive Care Units
030228 respiratory system
Emergency medicine
Female
Risk of death
Emergency Service, Hospital
business
Subjects
Details
- ISSN :
- 00903493
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Critical Care Medicine
- Accession number :
- edsair.doi.dedup.....cdf16bfcba361005601657b8c6b728e9