Introduction
Method
Study design and setting
Study population
Study variables
Cardiovascular and Neurologic Vital Signs | ||||||
---|---|---|---|---|---|---|
PRISM-3 score | Age Range: Neonate 0 to < 1 month Infant 1 to 12 month Child > 12 to 144 months Adolescent > 144 months | SBP (mm Hg) Neonate > 55 mmHg →0 Neonate 40–55 mmHg →3 Neonate < 40 mmHg →7 Infant > 65 mmHg →0 Infant 45–65 mmHg →3 Infant < 45 mmHg →7 Child > 75 mmHg →0 Child 55–75 mmHg →3 Child < 55 mmHg →7 Adolescent > 85 mmHg →0 Adolescent 65–85 mmHg →3 Adolescent < 65 mmHg →7 | Heart Rate (beats/minute) Neonate < 215 →0 Neonate 215–225 →3 Neonate > 225 →4 Infant < 215 →0 Infant 215–225 →3 Infant > 225 →4 Child < 185 →0 Child 185–205 →3 Child > 205 →4 Adolescent < 145 →0 Adolescent 145–155 →3 Adolescent > 155 →4 | Temp (°C) < 33→ 3 33–40 →0 > 40→ 3 | Mental status GCS ≥ 8→ 0 GCS < 8 →5 | Pupillary response Both reactive →0 1 reactive (1 fixed and > 3 mm) →7 Both fixed and both > 3 mm→11 |
Blood Gasometery | ||||||
Acidosis pH > 7.28 & TCO2 ≥ 17 mEq/L →0 pH 7.0–7.28 or TCO2 5–16.9 mEq/L →2 pH < 7.0 or TCO2 < 5 mEq/L →6 | PCO2 (mm Hg) < 50 →0 50–75→ 1 > 75 →3 | PH < 7.48 →0 7.48–7.55 →2 > 7.55 →3 | TCO2(mEq/L) ≤ 34 →0 > 34 →4 | PaO2 (mmHg) ≥ 50 →0 42–49.9 →3 < 42 → 6 | ||
Chemistry Tests | ||||||
Creatin (mg/dL) Neonate ≤0.85 →0 Neonate > 0.85 →2 Infant ≤0.90 →0 Infant > 0.90 →2 Child ≤0.90 →0 Child > 0.90 →2 Adolescent ≤1.30→0 Adolescent > 1.30 →2 | Potassium (mEq/L) ≤ 6.9 →0 > 6.9 →3 | Glucose (mg/dL) ≤ 200 →0 > 200 →2 | BUN (mg/dL) Neonate ≤11.9 →0 Neonate > 11.9 →3 Not neonate ≤14.9 →0 Not neonate > 14.9 →3 | |||
Hematologic Tests | ||||||
PT & PTT Neonate PT ≤ 22 s and PTT ≤ 85 s →0 Neonate PT > 22 s or PTT > 85 s →3 Not neonate PT ≤ 22 s & PTT ≤ 57 s →0 Not neonate PT > 22 s or PTT > 57 s →3 | Platelet (μL) > 200,000 →0 100,000–200,000 →2 50,000-99,999→ 4 < 50,000 →5 | WBC (μL) ≥ 3000 →0 < 3000 →4 | ||||
Logit = 0.207 × PRISM-3 score - (0.005 × (age in months) – 0.433 × 1 (if postoperative) – 4.782 | ||||||
PIM-3 score | PIM-3 score = (3.8233 × pupillary reaction) + (− 0.5378 × elective admission) + (0.9763 × mechanical ventilation) + (0.0671 × [absolute {base excess}]) + (− 0.0431 × SBP) + (0.1716 × [SBP2/1000]) + (0.4214 × [{FiO2 × 100}/PaO2]) − (1.2246 × bypass cardiac procedure) − (0.8762 × non-bypass cardiac procedure) − (1.5164 × noncardiac procedure) + (1.6225 × very high-risk diagnosis) + (1.0725 × high-risk diagnosis) − (2.1766 × low-risk diagnosis) − 1.7928. | |||||
Probability of death = exp. (PIM-3 score)/[1 + exp. (PIM-3 score)] |
Characteristics | PICU mortality | P-Value | In-hospital mortality | P-Value | Missing data | Number of Missing | |||
---|---|---|---|---|---|---|---|---|---|
Non-survive N = 304 | Survive N = 2142 | Non-Survive N = 395 | Survive N = 2051 | (N = 338) | |||||
Demographics | |||||||||
Age (Month) | 5.9(0.67–49.4) | 4(0.67–22) | 0.013 a | 6.4(0.9–51) | 3.93(0.63–21.17) | < 0.001 a | 3.6 (0.27–18.5) | 0 | |
Neonate (< 1 month) | 82(27.0%) | 604(28.2%) | 0.023 c | 101(14.8%) | 585(85.2%) | < 0.001 c | 100(29.6%) | 0 | |
Infant (1–12 month) | 94(30.9%) | 824(38.3%) | 125(13.7%) | 790(86.3%) | 136(40.2%) | 0 | |||
Child (12–144 month) | 117(38.5%) | 675(31.5%) | 150(19%) | 642(81%) | 98(29%) | 0 | |||
Adolescent (> 144 month) | 11(3.6%) | 42(2.0%) | 19(4.8%) | 34(1.7%) | 4(1.2%) | 0 | |||
Male | 161(53.0%) | 1218(56.9%) | 0.20 c | 209(9%) | 1170(47%) | 0.13 c | 197(58.3) | 0 | |
Female | 143(47.0%) | 924(43.1%) | 186(7.4%) | 881(36.6%) | 141(41.7) | 0 | |||
Vital signs | |||||||||
Temperature(°C) | 37(36.5–37.5) | 37(36–37) | 0.015 a | 37(36–37.5) | 37(36.8–37.4) | 0.14 a | 37(36–37.4) | 60 | |
Diastolic (mmHg) | 56(40–70) | 55(44–68) | 0.682 a | 56(40–69) | 55(44–68) | 0.561 a | 55(43–69) | 42 | |
Systolic (mmHg) | 95(73.2–111.8) | 97(81–110) | 0.038 a | 95(75–111) | 97(81–110) | < 0.001 a | 98(79–109) | 42 | |
Fio2(mmHg) | 40(29–90) | 21(21–40) | < 0.001 a | 40(29–80) | 21(21–40) | < 0.001 a | 21(21–40) | 0 | |
RR (breaths/min) | 38(28–44) | 38(28–44) | 0.114 a | 35(25–45) | 37(28–44) | 0.274 a | 35(25–42) | 35 | |
Pupillary response | Normal | 232(76.3%) | 2075(96.9%) | < 0.001b | 1996(81.6%) | 311(12.7%) | < 0.001b | 321(95.5%) | 0 |
Abnormal | 72(23.7%) | 67(3.1%) | 55(2.3%) | 84(3.4%) | 15(4.5%) | 0 | |||
Lab result tests | |||||||||
Glucose (mg/dL) | 124.5(92–178) | 110(87–143) | < 0.001 a | 122(90–170) | 110(87–143) | 0.001 a | 93(71–129.7) | 0 | |
Urea (mg/dL) | 32.8(19–51) | 21(14–33) | < 0.001 a | 30(18–48) | 21(14–33) | < 0.001 a | 20(14–30) | 0 | |
Cr (mg/dL) | 0.90(0.5–1) | 0.5(0.5–0.7) | < 0.001 a | 0.85(0.5–0.9) | 0.78(0.5–0.7) | < 0.001 a | 0.58(0.5–0.71) | 0 | |
K (mEq/L) | 4.3(3.5–4.9) | 4.4(3.9–4.8) | 0.022 a | 4.3(3.5–4.9) | 4.4(3.9–4.8) | 0.003 a | 4.22(3.7–4.7) | 48 | |
GCS | 12(7–15) | 15(13–15) | < 0.001 a | 12(7–15) | 15(13–15) | < 0.001 a | 15(13–15) | 71 | |
Plate let (103 cells/mm3) | 155(56.5–273) | 296(202–419) | < 0.001 a | 159(56–278) | 300(207–421) | < 0.001 a | 291(183–432) | 89 | |
PT | 14.5(12.6–20.7) | 13(12–14) | < 0.001 a | 14(12.5–19.4) | 13(12–14) | < 0.001 a | 13(12–14) | 97 | |
PTT | 36(30–48) | 32(29–36) | < 0.001 a | 35(30–45) | 32(29–36) | < 0.001 a | 32(30–37) | 65 | |
HR (beats/min) | 139(118–156.7) | 136(120–153) | 0.455 a | 138(119–156) | 136(120–153) | 0.427 a | 133(120–151) | 42 | |
WBC (103 cells/mm3) | 11.7(6.4–17.3) | 8.3(11.6–16.1) | 0.394 a | 11.4(6.1–17.0) | 11.7 (8.4–16.1) | 0.041 a | 11(8.5–15.8) | 89 | |
PCO2(mmHg) | 32(26.5–39.7) | 32.4(26.6–39) | 0.480 a | 35(27–42) | 32(26–38) | 0.775 a | 36.9(30.1–43.4) | 18 | |
PH | 7.34(7.24–7.41) | 7.37(7.30–7.41) | < 0.001 a | 7.34(7.26–7.41) | 7.37(7.30–7.41) | < 0.001 a | 7.34(7.29–7.39) | 18 | |
TCO2(mEq/L) | 20.4(16.1–23.6) | 21(18–236) | 0.06 a | 21(16.5–24.2) | 21(18–23.5) | 0.384 a | 21.34(19–24.3) | 18 | |
PaO2(mmHg) | 94(92–99) | 95.9(95–99) | 0.004 a | 93.93(92–99) | 96.04(94–100) | < 0.001 a | 97(95–99) | 18 | |
Readmission | 79(26%) | 523(24.4%) | 0.298 b | 105(26.6%) | 497(24.2%) | 0.176 b | 138(40.8%) | 0 | |
Type admission | |||||||||
Emergency | 108(35.3%) | 618(28.9%) | 0.008 c | 584(25%) | 142(5%) | 0.001 c | 133(39.3%) | 0 | |
Referral | 142(46.7%) | 1035(48.3%) | 995(41%) | 182(7%) | 171(50.6%) | 0 | |||
Elective | 54(17.8%) | 489(22.8%) | 472(20%) | 71(2%) | 34(10.1%) | 0 | |||
Type of diagnosis based on PIM-3 | |||||||||
Very High Risk | 104(34.2%) | 98(4.5%) | < 0.001 c | 127(32.2%) | 75(3.7%) | < 0.001 c | 11(3.3%) | 0 | |
High Risk | 42(13.8%) | 46(2.1%) | 53(13.4%) | 35(1.7%) | 3(0.9%) | 0 | |||
Low Risk | 36(11.8%) | 174(8.1%) | 51(12.9%) | 159(7.8%) | 5(1.5%) | 0 | |||
Mechanical ventilation | 70(23%) | 159(7.45%) | < 0.001 b | 89(3.7%) | 140(5.7%) | < 0.001b | 39(11.5%) | 0 | |
PRISM-3 score | 12(8,19) | 5(2,8.2) | < 0.001 a | 11(7,19) | 5(2,8) | < 0.001 a | 5(2–9) | 0 | |
PIM-3 score | 4(2,9) | 2.(2,3) | < 0.001 a | 4(2,8) | 2.(2,3) | < 0.001 a | 2(2–4) | 0 | |
LOS in Hospital (day) | 11(5–23.7) | 8(4–15) | < 0.001 a | 12(5–26) | 8(4–15) | < 0.001 a | 9(4–17) | 0 | |
LOS in ICU (day) | 8(3–18.5) | 7(3.7–13) | < 0.029 a | 8(3–19) | 7(4–12) | 0.004 a | 7(4–14) | 0 | |
Type of diagnosis based on the ICD-10 | |||||||||
Congenital malformation | 62(20.4%) | 539(25.2%) | 0.365 c | 88(22.3%) | 513(85.3%) | 0.266 c | 114(33.7%) | 0 | |
Diseases of the digestive system | 43(14.1%) | 296(13.8%) | 54(13.7%) | 285(84.0%) | 63(18.6%) | 0 | |||
Diseases of the respiratory system | 42(13.8%) | 224(10.5%) | 51(12.9%) | 215(80.8%) | 31(9.2) % | 0 | |||
Neoplasms, Diseases of the blood | 34(11.2%) | 167(7.8%) | 43(10.9%) | 158(78.6%) | 17(5.1%) | 0 | |||
Diseases of genitourinary system | 15(4.9%) | 94(4.4%) | 23(5.82%) | 86(78.8%) | 11 (3.3%) | 0 | |||
Infectious diseases | 15(4.9%) | 115(5.4%) | 22(5.6%) | 108(83%) | 8 (2.4%) | 0 | |||
Metabolic diseases | 15(4.9%) | 102(4.8%) | 18(4.6%) | 99(84.6%) | 12 (3.6%) | 0 | |||
Diseases of the circulatory system | 10(3.3%) | 73(3.4%) | 14(3.5%) | 69(83.1%) | 10 (3%) | 0 | |||
Diseases of the nervous system | 8(2.6%) | 55(2.6%) | 8(2%) | 55(87.3%) | 7(2.1%) | 0 | |||
Certain conditions originating in the perinatal period | 6(2%) | 61(2.8%) | 7(1.8%) | 60(89.6%) | 15(4.4%) | 0 | |||
Other disease | 54(17.8%) | 416(19.3%) | 67(16.9%) | 403(85.8%) | 50(14.7%) | 0 |
Characteristics | PICU mortality | P-Value | In-hospital mortality | P-Value | |||
---|---|---|---|---|---|---|---|
Non-survive N = 338 | Survive N = 2446 | Non-Survive N = 434 | Survive N = 2350 | ||||
Demographics | |||||||
Age (month) | 5.1(0.49–42.7) | 3.98(0.63–21.4) | 0.031 a | 5.7(0.7–47.8) | 3.9(0.6–20.7) | < 0.001 a | |
Neonate (< 1 month) | 95(28.1%) | 691(28.2%) | 0.016 c | 115(26.4%) | 671(28.6%) | < 0.001 c | |
Infant (1–12 month) | 106(31.4%) | 944(38.6%) | 138(31.8%) | 912(38.8%) | |||
Child (12–144 month) | 126(37.3%) | 765(31.3%) | 162(37.4%) | 729(31.0%) | |||
Adolescent (> 144 month) | 11(3.2%) | 46(1.9%) | 19(4.4%) | 38(1.6%) | |||
Male | 181(53.5%) | 1393(57%) | 0.242 c | 232(53.5%) | 1342(57.1%) | 0.155 c | |
Female | 157(46.5%) | 1053(43%) | 202(46.5%) | 1008(42.9%) | |||
Vital signs | |||||||
Temperature(°C) | 37(36.5–37.5) | 37(36.8–37.4) | 0.008 a | 37(36–37.5) | 37(36.8–37.4) | 0.086 a | |
Diastolic (mmHg) | 56(40–69) | 55(44–68) | 0.512 a | 56(40–69) | 55(44–68) | 0.440 a | |
Systolic (mmHg) | 95(72–110) | 97(81–110) | 0.006 a | 95(73–110) | 97(81–110) | 0.009 a | |
Fio2(mmHg) | 40(21–90) | 21(21–40) | < 0.001 a | 40(28–80) | 21(21–40) | < 0.001 a | |
RR (breaths/min) | 35(25–44) | 37(28–43) | 0.109 a | 35(25–44) | 37(28–43) | 0.287 a | |
Pupillary response | Normal | 260 (9.9%) | 2370(90.1%) | < 0.001c | 343(13.1%) | 2287(86.9%) | < 0.001c |
Abnormal | 78(50.6%) | 76(49.4%) | 91(59.1%) | 63(40.9%) | |||
Lab result tests | |||||||
Glucose (mg/dL) | 122.0(90–176) | 108(85–142) | < 0.001 a | 120(90–167) | 108(85–142) | < 0.001 a | |
Urea (mg/dL) | 31.9(19–49.9) | 21(14–33) | < 0.001 a | 30(18–48) | 21(14–31) | < 0.001 a | |
Cr (mg/dL) | 0.76(0.5–0.7) | 0.88(0.5–1) | < 0.001 a | 0.76(0.5–0.7) | 0.84(0.5–0.9) | < 0.001 a | |
K (mEq/L) | 4.3(3.5–4.8) | 4.4(3.8–4.8) | 0.020 a | 4.2(3.5–4.8) | 4.4(3.9–4.8) | 0.002 a | |
GCS | 12(7–15) | 15(13–15) | < 0.001 a | 12(7–15) | 15(13–15) | < 0.001 a | |
Platelet (103 cells/mm3) | 158(61–273) | 298(202–420.7) | < 0.001 a | 163(61–277.5) | 301(206–425) | < 0.001 a | |
PT | 14.5(12.7–20.2) | 13(12–14) | < 0.001 a | 14(12.5–19.2) | 13(12–14) | < 0.001 a | |
PTT | 36(30–47) | 32(29–36) | < 0.001 a | 35(30–45) | 32(29–36) | < 0.001 a | |
HR (beats/min) | 138(117–157) | 136(120–152) | 0.411 a | 138(119–156) | 136(120–153) | 0.539 a | |
WBC (103 cells/mm3) | 11.9(6.5–17.3) | 11.6(8.4–16) | 0.63 a | 11.5(6.1–17.0) | 11.6 (8.4–16.0) | 0.08 a | |
PCO2(mmHg) | 33.8(27.3–40.1) | 32.9(26.9–39.7) | 0.165 a | 33.3(27.4–39.7) | 33(26.9–39.8) | 0.608 a | |
PH | 7.34(7.23–7.41) | 7.36(7.30–7.41) | < 0.001a | 7.34(7.25–7.41) | 7.36(7.30–7.41) | < 0.001 a | |
TCO2(mEq/L) | 20.6(16.4–24.0) | 21(18.2–23.6) | 0.098 a | 21(16.6–24.4) | 21(18.3–23.6) | 0.386 a | |
PaO2(mmHg) | 94(92–99) | 95.9(95–99) | 0.004 a | 94(92–99) | 96(94–100) | < 0.001 a | |
Readmission | 1.66 ± 1.55 | 1.54 ± 1.17 | 0.001 a | 1.65 ± 1.5 | 1.54 ± 1.17 | < 0.001 a | |
Type admission | |||||||
Emergency | 120(35.5%) | 738(30.2%) | 0.001 c | 156(36.0%) | 702(29.9%) | 0.029 c | |
Referral | 158(46.7%) | 1191(48.7%) | 201(46.3%) | 1148(48.9%) | |||
Elective | 60(17.8%) | 517(21.1%) | 77(17.7%) | 500(21.2%) | |||
Type of diagnosis based on PIM-3 | |||||||
Very High Risk | 111(32.8%) | 102(4.17%) | < 0.001 c | 134(30.9%) | 79(2.6%) | < 0.001 c | |
High Risk | 23(6.8%) | 43(1.75%) | 30(7%) | 36(1.5%) | |||
Low Risk | 23(6.8%) | 164(6.7%) | 33(7.6%) | 154(6.6%) | |||
Mechanical ventilation | 70(20.7%) | 159(6.5%) | < 0.001 b | 101(23.3%) | 165(7%) | < 0.001c | |
PRISM-3 score | 12(8,19) | 5(2,8.2) | < 0.001 a | 11(7,18) | 5(2,8) | < 0.001 a | |
PIM-3 score | 4(2,8) | 2(2,3) | < 0.001 a | 4(2,8) | 2(2,3) | < 0.001 a | |
LOS in Hospital (day) | 12(5–23) | 8(4–15) | < 0.001 a | 12(5–25.2) | 8(4–15) | < 0.001 a | |
LOS in ICU (day) | 8(3–17) | 7(4–13) | < 0.008 a | 8(3–19) | 7(4–13) | 0.001 a | |
Type of diagnosis based on the ICD-10 | |||||||
Congenital malformation | 69(20.5%) | 646(26.4%) | 0.079 c | 97(22.4%) | 618(26.3%) | 0.071 c | |
Diseases of the digestive system | 50 (14.8%) | 353(14.4%) | 62(14.3%) | 341(14.5%) | |||
Diseases of the respiratory system | 45(13.3%) | 252(10.3%) | 55(12.7%) | 242(10.3%) | |||
Neoplasms, Diseases of the blood | 41(12.1%) | 178(7.2%) | 50(11.5%) | 169(7.2%) | |||
Diseases of genitourinary system | 16(4.7%) | 104(4.2%) | 24(5.5%) | 96 (4.1%) | |||
Infectious diseases | 15(4.4%) | 123(5.0%) | 22(5.1%) | 116(4.9%) | |||
Metabolic diseases | 16(4.7%) | 113(4.6%) | 20(4.6%) | 109(4.6%) | |||
Diseases of the circulatory system | 10(3.0%) | 83(3.4%) | 14(3.2%) | 79(3.4%) | |||
Diseases of the nervous system | 9(2.7%) | 61(2.5%) | 9(2.1%) | 61(2.6%) | |||
Certain conditions originating in the perinatal period | 9(2.7%) | 74(3.0%) | 10(2.3%) | 73(3.1%) | |||
Other disease | 58(17.1%) | 459(19%) | 71(16.3%) | 446(19%) |
Statistical analyses
Results
Outcome | Age group | MODEL | AUC 95%CI | Quintiles of risk | Total | Exp | Obs | SMR | HL | BS | Cut-off | Sen | Spe | PPV | NPV | Acc |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
PICU mortality | Total | PRISM-3 | 0.831(0.814–0.854) | 1:PRISM-3 | 687 | 6.97 | 2 | 1.34 | < 0.001 | 0.088 | 6.5 | 0.881 | 0.632 | 0.253 | 0.974 | 0.663 |
PIM-3 | 0.745(0.722–0.781) | 2:PRISM-3 | 333 | 15.01 | 14 | 0.014 | 0.093 | 2.5 | 0.700 | 0.666 | 0.229 | 0.940 | 0.670 | |||
Neonate | PRISM-3 | 0.841(0.813–0.868) | 3:PRISM-3 | 506 | 40.31 | 40 | 0.118 | 0.087 | 6.5 | 0.878 | 0.620 | 0.239 | 0.974 | 0.651 | ||
PIM-3 | 0.752(0.710–0.794) | 4:PRISM-3 | 484 | 60.39 | 90 | 0.037 | 0.091 | 3.5 | 0.500 | 0.837 | 0.294 | 0.925 | 0.797 | |||
Infant | PRISM-3 | 0.855(0.819–0.891) | 5:PRISM-3 | 436 | 104.5 | 158 | 0.003 | 0.073 | 6.5 | 0.893 | 0.693 | 0.250 | 0.982 | 0.713 | ||
PIM-3 | 0.804(0.752–0.856) | 1:PIM-3 | 391 | 0 | 9 | 1.37 | 0.071 | 0.076 | 4.5 | 0.595 | 0.883 | 0.368 | 0.950 | 0.853 | ||
Child | PRISM-3 | 0.811(0.774–0.849) | 2:PIM-3 | 1127 | 65.98 | 82 | < 0.001 | 0.102 | 7.5 | 0.846 | 0.654 | 0.298 | 0.960 | 0.683 | ||
PIM-3 | 0.736(0.686–0.786) | 3:PIM-3 | 231 | 21.26 | 30 | 0.003 | 0.107 | 2.5 | 0.658 | 0.675 | 0.260 | 0.919 | 0.672 | |||
Adolescent | PRISM-3 | 0.697(0.523–0.871) | 4:PIM-3 | 405 | 52.39 | 60 | 0.927 | 0.144 | 11.5 | 0.727 | 0.574 | 0.285 | 0.90 | 0.603 | ||
PIM-3 | 0.775(0.614–0.936) | 5:PIM-3 | 292 | 82.18 | 123 | 0.861 | 0.141 | 3.5 | 0.818 | 0.574 | 0.310 | 0.931 | 0.620 | |||
Hospital A with 1380 patients: AUC for PRISM-3: 0.839(0.808–0.869) with 0.15 Standard Error & AUC for PIM-3: 0.744(0.697–0.790) with 0.24 Standard Error Hospital B with 1404 patients: AUC for PRISM-3: 0.821(0.793–0.850) with 0.14 Standard Error & AUC for PIM-3: 0.743(0.703–0.783) with 0.20 Standard Error | ||||||||||||||||
In-hospital mortality | Total | PRISM-3 | 0.781 (0.759–0.808) | 1:PRISM-3 | 687 | 6.97 | 30 | 1.73 | 0.068 | 0.108 | 6.5 | 0.785 | 0.636 | 0.294 | 0.939 | 0.660 |
PIM-3 | 0.737 (0.718–0.771) | 2:PRISM-3 | 333 | 15.01 | 28 | 0.026 | 0.113 | 2.5 | 0.689 | 0.680 | 0.293 | 0.919 | 0.681 | |||
Neonate | PRISM-3 | 0.777(0.727–0.827) | 3:PRISM-3 | 506 | 40.31 | 49 | 0.765 | 0.104 | 9.5 | 0.614 | 0.807 | 0.354 | 0.924 | 0.778 | ||
PIM-3 | 0.753(0.701–0.805) | 4:PRISM-3 | 484 | 60.39 | 97 | 0.183 | 0.102 | 2.5 | 0.644 | 0.762 | 0.319 | 0.925 | 0.745 | |||
Infant | PRISM-3 | 0.768(0.719–0.816) | 5:PRISM-3 | 436 | 104 | 191 | 0.299 | 0.095 | 6.5 | 0.744 | 0.692 | 0.277 | 0.945 | 0.699 | ||
PIM-3 | 0.761(0.711–0.811) | 1:PIM-3 | 391 | 0 | 16 | 1.78 | 0.237 | 0.099 | 3.5 | 0.672 | 0.725 | 0.279 | 0.933 | 0.718 | ||
Child | PRISM-3 | 0.775(0.733–0.816) | 2:PIM-3 | 1127 | 65.98 | 107 | 0.034 | 0.125 | 7.5 | 0.773 | 0.663 | 0.349 | 0.926 | 0.684 | ||
PIM-3 | 0.726(0.680–0.772) | 3:PIM-3 | 231 | 21.26 | 40 | 0.130 | 0.129 | 2.5 | 0.646 | 0.690 | 0.327 | 0.893 | 0.681 | |||
Adolescent | PRISM-3 | 0.822(0.701–0.942) | 4:PIM-3 | 405 | 52.39 | 88 | 0.876 | 0.188 | 14 | 0.684 | 0.746 | 0.565 | 0.828 | 0.724 | ||
PIM-3 | 0.840(0.726–0.953) | 5:PIM-3 | 292 | 82.18 | 144 | 0.486 | 0.197 | 3.5 | 0.842 | 0.666 | 0.551 | 0.896 | 0.724 | |||
Hospital A with 1380 patients: AUC for PRISM-3: 0.784 (0.747–0.821) with 0.19 Standard Error & AUC for PIM-3: 0.725(0.681–0.769) with 0.23 Standard Error Hospital B with 1404 patients: AUC for PRISM-3: 0.773(0.740–0.805) with 0.17 Standard Error & AUC for PIM-3: 0.740 (0.705–0.775) with 0.18 Standard Error |
Discussion
Main findings
Study | Country | Sample Size(N) | Male Gender (%) | Age Mean ± SD Md (IQR) | Mortality Rate (%) | DX. | Score Mean ± SD Md (IQR) | AUC (95% CI) | Number of ICU | H-L
P-value | Outcomea | SMR (95% CI) | LOS Mean ± SD Md (IQR) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
[14] | ITALY | 11,109 | 75% | 68 (55–80) m | 3.9% | Case-mix | PIM-3: 6 (5–8) | PIM-3:0.88 (0.86–0.89) | 17 units | P:0.21 | P | PIM-3:0.98 (0.89–1.08) | 6.1 ± 15.5 2 (1–6) |
[10] | Australia, New Zealand Ireland, UK | 53,112 | NA | NA | NA | Case-mix | NA | PIM-3:0.88 (0.88–0.89) | 60 units | p > 0.95 | P | PIM-3:1 (0.99–1.01) | NA |
[15] | Australia New Zealand | 26,966 | NA | NA | 4.3% | Case-mix | NA | PRISM-3:0.93 (0.92–0.94) | 10 units | P < 0.001 | P | PRISM-3:0.77 (0.72–0.82) | NA |
[16] | Australia New Zealand | 4403 | 55.5% | 2.1 (0.6–6.6) m | 5.2% | Invasive infection | NA | PIM-3:0.77 (0.730–0.81) | NA | NA | P | NA | 4.72 ± 7.47 |
[17] | Poland | 303 | 56.7% | Md:15.9 | 6.6% | Case-mix | NA | PRISM-3:0.78 (0.67–0.89) | NA | P: 0.21 | P | PRISM-3:0.95 (0.68–1.23) | 8.4 (2.0) |
[18] | Portuguese | 556 | 60% | 65 (1–17) m | 5% | Case-mix | PRISM-3: 5(0–46) | PRISM-3:0.92 (0.86–0.97) | Single | p: 0.282 | P | PRISM-3:0.94 (0.60–1.28) | 3 (0–155) |
[8] | Poland | 12,040 | NA | NA | 3.40% | Case-mix | NA | PRISM-3:0.90 (0.89–92) | 7 units | NA | P | PRISM-3:0.87 (0.79–096) | NA |
[19] | Greek | 300 | 64.6% | 49.93 ± 54.26 m | 11.1% | Case mix | NA | PRISM-3: 0.89 (0.82–0.96) | Single | P:0.989 | P | PRISM-3:0.99 (0.67–1.43) | 8.85 ± 23.28 |
[20] | UK | 10,197 | 57% | 16.8 (2.4–79.2) m | 6.2% | Case-mix | NA | PRISM-3: 0.82 (0.80–0.84) | 18 units | p < 0.001 | p | NA | Md:46.2 |
[21] | Belgium Netherlands Canada | 1428 | NA | 1.44 (0.3–6.4) Yr. | 4% | Case-mix | PRISM-3:8 (4–13) PIM-3: −3.5 (−4.4, −2.4) | PRISM-3:0.92 (0.91–0.92) PIM-3:0.89 (0.89–0.89) | 3 units | P:0.04 P:0.5 | p | NA | 68 ± 4.8 |
[22] | Austria | 398 | 55.8% | 29.6 (3.8–105.6) m | 13.6% | sepsis | (NA) | PRISM-3: 0.75 (0.68–0.75) PIM-3: 0.76 (0.68–0.76) | single | NA | P | NA NA | NA |
[23] | Egypt | 123 | 64.2% | 5 (1–15) Yr. | 20% | Case-mix | PRISM-3:36 (NA) | PRISM-3:0.91 (0.85–0.98) | Single | P: 0.65 | p | NA | Mdn:5 |
[24] | Egypt | 135 | 64.1% | 26.4 ± 20.8 m | 40% | Case-mix | PRISM-3: 6.02 ± 5.48 | PRISM-3:0.875 | Single | NA | P | NA | NA |
[25] | Egypt | 100 | 58% | 8 (4–36) m | 17% | Case-mix | (NA) | PRISM-3: 0.98 (0.96–1.0) PIM-3:0.97 (0.87–0.99) | single | p < 0.001 p < 0.001 | H | PRISM-3: 2.11 PIM-3: 2.44 | 7(4,11) |
[26] | India | 723 | 59.1% | 26.85 m | 14.8% | Case-mix | NA | PRISM-3: (x > 0.86) | Single | P:0.395 | P | PRISM-3: 1.01 (0.82–1.20) | NA |
[12] | India | 350 | 56.2% | 12 (4–60) m | 39.4% | Case-mix | NA | PRISM-3:0.66 (0.60–0.72) PIM-3:0.72 (0.67–0.78) | Single | P:0.747 P:0.059 | P | PRISM-3:.90 (1.06–1.09) PIM-3:1.09 (0.91–1.27) | 5(2–9) |
[27] | Pakistan | 370 | 64% | 19 ± 25.8 m | 23.8% | Case-mix | PRISM-3: 14 ± 7.30 | PRISM-3:0.88 (0.84–0.92) | Single | P:0.244 | P | NA | 3 ± 1 |
[28] | Thailand | 588 | 53.2% | 37.9 (9.8–105) m | 13.6% | Case-mix | PRISM-3: 4(0.8–9) | PRISM-3:0.845 | single | NA | P | PRISM-3:0.98 (0.77–1.19) | 3.5 (2–7.2) |
[29] | Korea | 503 | 59% | 4.8 ± 4.6 Yr. | 19.9% | Case-mix | NA | PRISM-3: 0.77 (0.73–0.81) PIM- 3: 0.82 (0.79–0.85) | Single | P:0.498 P:0.333 | P | PRISM-3:NA PIM-3:1.1 (0.91–1.3) | 17.1 ± 34.5 |
[30] | Korea | 1710 | 59.2% | 1.5 (0.3–7.8) Yr. | 8.47% | Case-mix | NA | PIM-3:0.76 (0.72–0.80) | Single | 0.313 | P | NA | 3 (1–8) |
[31] | China | 852 | 60.8% | 6.5 (2–21) m | 12.5% | Case-mix | PRISM-3: 11 ± 13.94 | PRISM-3:0.72 (0.67–0.78) | single | p: 0.51 | P | PRISM-3:1.14 (0.93–1.36) | 8(4–15) |
[32] | China | 1109 | NA | NA | 10.4% | Case-mix | NA | PRISM-3: 0.82 (0.78–0.86) | single | p: 0.61 | H | NA | NA |
[2] | USA | 3490 | 49% | 16.4 (6.2–50.4) m | 6.8% | Pulmonary hypertension | NA | PRISM-3:0.71 NA | 143 units | NA | P | NA | NA |
[33] | USA | 178 | NA | 29 day-17Yr. | 26% | Respiratory failure | Center1:19 (12–26) Center2:15 (11–21) Center3:9 (6–21) | PRISM-3:0.56 (0.46–0.66) | 3 units | NA | P | NA | 27(14–40]) 39(19–63) 25 (13–54) |
[34] | Brazil | 359 | 55% | 31 (11–94) m | 15% | Case-mix | PRISM-3: 15 (8–21) | PRISM-3:0.76 (0–69–0-83) | Single | p : 0.11 | P | NA | 5 (3–10) |
[35] | Brazil | 237 | 56% | 12 (1–144) m | 39% | Case-mix | PRISM-3:19 (9–42) | PRISM-3: 0.72 (0.66–0.79) | Single | P: 0.5 | p | PRISM-3:1 (0.80–1.20) | Mean:7.5 Md:7.0 |
[36] | Argentina | 6602 | 56.1% | 20 (5–74) m | 8% | Case-mix | NA | PIM-3:0.83 (0.82–0.85) | 59 units | P < 0.001 | P | PIM-3:1.3 (1.2–1.42) | 5 (2–10) |
[37] | Iran | 221 | 57% | 30 ± 5.85 m | 21.3% | Case-mix | NA | PRISM-3:80.3 | single | P:0.80 | P | NA | NA |
[38] | Iran | 221 | 54% | 29.85 ± 35.07 m | 9.05% | Case-mix | PRISM-3: 14.2 ± 9.57 | PRISM-3:0.89 (0.83–0.96) | single | P:0.161 | P | PRISM-3:1.05 (NA) | 5.16 ± 4.03 |
[39] | Iran | 90 | 73.3% | 93.6 (40.4146.7) m | 17.8% | Case-mix | PRISM-3: 10.8 ± 5.1 PIM-3: 1.97 ± 1.30 | PRISM-3:0.77 (0.71,0.83) PIM-3:0.82 (0.76,0.87) | single | P:0.79 P:0.93 | P | NA NA | 3.65 ± 3.95 |
[40] | Iran | 365 | 60.2% | 49 m | 10.4% | Case-mix | PIM-3:1.45 ± (NA) | PIM-3:0.711 (0.63–0.80) | single | P < 0.001 | P | PIM-3:7.18 (NA) | NA |
THIS study | Iran | 2446 | 5 6% | 4.21 (0.66–24.1) m | 16.1% | Case-mix | PIM-3: 2 ± 2.9 PRISM-3: 6 ± 6.5 | PRISM-3:0.82 (0.80–0.85) PIM-3:0.74 (0.71–0.77) | 6 units | P < 0.001 P:0.014 | P&H | PRISM:1.34 (1.19–1.49) PIM:1.37 (1.21–1.52) | 8(4–16) |