A tertiary care center-based study of a novel ‘ICU Mortality and Prolonged Stay Risk Scoring System’

Abstract

Background & objective: Intensive care has been associated with high cost and resource-intensive medical care. Therefore, a risk prediction model is required to plan time allocation, human resources, and the required equipment. Various risk predictions for ICU mortality and ‘Prolonged Length of Stay’ (PLOS) scores are already available. Still, the established model, such as the APACHE IV score or SAPS II, sometimes became impractical since they required many laboratory parameters. A model based on co-morbidities and demographic factors may be more useful in limited resources setting. Hence, we developed a simple ICU mortality and PLOS risk prediction model based on co-morbidities and demographic data.

Methodology: This retrospective cohort study was performed to develop a risk scoring for mortality and PLOS, using data from Dr. Sardjito Hospital Yogyakarta database between January 01-December 31, 2019. Logistic regression and bootstrap methods were used to create a risk score for estimating the risk. The discrimination performance of the model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC). The Hosmer-Lemeshow test was employed to assess the model’s calibration.  

Results: A total of 415 patients were included in this study. The risk factors for mortality were perioperative support medication, kidney failure, neurologic disorder, respiratory failure, and intraoperative blood transfusion. The mortality score of 6 was associated with a 100% probability of mortality. Medical cases, GCS < 8, vasoactive/inotropic medication, sepsis, respiratory failure, and kidney failure were the risk factors for PLOS. PLOS score of 3 was associated with a 100% probability of PLOS. The discrimination for either mortality or PLOS was considered excellent with the AUC (± 95% CI) for mortality 0.896 (0.853-0.94), while for PLOS 0.878 (0.80-0.90). The calibration test found that both models had good calibration with P values of 0.53 and 0.55 for mortality and PLOS, respectively.

Conclusion: The ‘Mortality and Prolonged Length of Stay Prediction Score’ based on co-morbidities and demographic data upon admission to ICU had good accuracy and can be applied as a potential new scoring system in healthcare institutions.

Abbreviations: APACHE- Acute Physiologic Assessment and Chronic Health Evaluation; AUC; Area Under the Curve GCS- Glasgow Coma Scale; ICU- Intensive Care Unit; PLOS- ‘Prolonged Length of Stay’; PRC- Packed Red Cells; SAPS- Simplified Acute Physiology Score

Keywords: Risk Scoring; Mortality; Prolonged Length of Stay; ICU

Citation: Widyastuti Y, Jufan AY, Widodo U, Wisudarti CFR, Sudadi, Fauzi RA, Ardiansyah F. A tertiary care center-based study of a novel ‘ICU Mortality and Prolonged Stay Risk Scoring System’. Anaesth. pain intensive care 2024;28(1):100−107; DOI: 10.35975/apic.v28i1.2382

Received: October 02, 2023; Reviewed: November 27, 2023; Accepted: December 17, 2023