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01.11.2003 | Original Article

Probability of mortality of critically ill cancer patients at 72 h of intensive care unit (ICU) management

verfasst von: Jeffrey S. Groeger, Jill Glassman, David M. Nierman, Susannah Kish Wallace, Kristen Price, David Horak, David Landsberg

Erschienen in: Supportive Care in Cancer | Ausgabe 11/2003

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Abstract

Goals

To develop and validate a model for probability of hospital mortality for cancer patients at 72 h of intensive care unit (ICU) management.

Patients and methods

This is an inception cohort study performed at four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 827 patients and then validated on an additional 415 patients. Multiple logistic regression modeling was used to develop the models, which were subsequently evaluated for discrimination and calibration. The main outcome measure is in-hospital death.

Results

A probability of mortality model, which incorporates ten discrete categorical variables, was developed and validated. All variables were collected at 72 h of ICU care. Variables included evidence of disease progression, performance status before hospitalization, heart rate >100 beats/min, Glasgow coma score ≤5, mechanical ventilation, arterial oxygen pressure/fractional inspiratory oxygen (PaO₂/FiO₂) ratio <250, platelets <100 k/µl, serum bicarbonate (HCO₃)<20 mEq/l, blood urea nitrogen (BUN) >40 mg/dl, and a urine output of <150 ml for any 8 h in the previous 24 h. The p values for the fit of the preliminary and validation models were 0.535 and 0.354 respectively, and the areas under the receiver operating characteristic (ROC) curves were 0.809 and 0.820.

Conclusions

We report a multivariable logistic regression model to estimate the probability of hospital mortality in critically ill cancer patients at 72 h of ICU care. The model is comprised of ten unambiguous and readily available variables. When used in conjunction with clinical judgment, this model should improve discussions about goals of care of these patients. Additional validation in a community hospital setting is warranted.

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Titel: Probability of mortality of critically ill cancer patients at 72 h of intensive care unit (ICU) management
verfasst von: Jeffrey S. Groeger
Jill Glassman
David M. Nierman
Susannah Kish Wallace
Kristen Price
David Horak
David Landsberg
Publikationsdatum: 01.11.2003
Verlag: Springer-Verlag
Erschienen in: Supportive Care in Cancer / Ausgabe 11/2003
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-003-0498-9

Springer Medizin

Probability of mortality of critically ill cancer patients at 72 h of intensive care unit (ICU) management