Prediction of mortality in intensive care unit cardiac surgical patients☆☆☆

Abstract

The purpose of this study was to develop a specific postoperative score in intensive care unit (ICU) cardiac surgical patients for the assessment of organ dysfunction and survival. To prove the reliability of the new scoring system, we compared its performance to existing ICU scores. This prospective study consisted of all consecutive adult patients admitted after cardiac surgery to our ICU over a period of 5.5 years. Variables were evaluated using the patients of the first year who stayed in ICU for at least 24h. The reproducibility was then tested in two validation sets using all patients. Performance was assessed with the Hosmer-Lemeshow (HL) goodness-of-fit test and receiver operating characteristic (ROC) curves and compared with the Acute Physiology and Chronic Health Evaluation (APACHE II) and Multiple Organ Dysfunction Score (MODS). The outcome measure was defined as 30-day mortality. A total of 6007 patients were admitted to the ICU after cardiac surgery. Mean HL values for the new score were 5.8 (APACHE II, 11.3; MODS, 9.7) for the construction set, 7.2 (APACHE II, 8.0; MODS, 4.5) for the validation set I and 4.9 for the validation set II. The mean area under the ROC curve was 0.91 (APACHE II, 0.86; MODS, 0.84) for the new score in the construction set, 0.88 (APACHE II, 0.84; MODS, 0.84) in the validation set I and 0.92 in the validation set II. Most of general ICU scoring systems use extensive data collection and focus on the first day of ICU stay. Despite this fact, general scores do not perform well in the prediction of outcome in cardiac surgical patients. Our new 10-variable risk index performs very well, with calibration and discrimination very high, better than general severity systems, and it is an appropriate tool for daily risk stratification in ICU cardiac surgery patients. Thus, it may serve as an expert system for diagnosing organ failure and predicting mortality in ICU cardiac surgical patients.