Derivation and Validation of a Novel Cardiac Intensive Care Unit Admission Risk Score for Mortality.
Publication/Presentation Date
9-3-2019
Abstract
Background There are no risk scores designed specifically for mortality risk prediction in unselected cardiac intensive care unit (CICU) patients. We sought to develop a novel CICU-specific risk score for prediction of hospital mortality using variables available at the time of CICU admission. Methods and Results A database of CICU patients admitted from January 1, 2007 to April 30, 2018 was divided into derivation and validation cohorts. The top 7 predictors of hospital mortality were identified using stepwise backward regression, then used to develop the Mayo CICU Admission Risk Score (M-CARS), with integer scores ranging from 0 to 10. Discrimination was assessed using area under the receiver-operator curve analysis. Calibration was assessed using the Hosmer-Lemeshow statistic. The derivation cohort included 10 004 patients and the validation cohort included 2634 patients (mean age 67.6 years, 37.7% females). Hospital mortality was 9.2%. Predictor variables included in the M-CARS were cardiac arrest, shock, respiratory failure, Braden skin score, blood urea nitrogen, anion gap and red blood cell distribution width at the time of CICU admission. The M-CARS showed a graded relationship with hospital mortality (odds ratio 1.84 for each 1-point increase in M-CARS, 95% CI 1.78-1.89). In the validation cohort, the M-CARS had an area under the receiver-operator curve of 0.86 for hospital mortality, with good calibration (P=0.21). The 47.1% of patients with M-CARS0.8%, and the 5.2% of patients with M-CARS >6 had hospital mortality of 51.6%. Conclusions Using 7 variables available at the time of CICU admission, the M-CARS can predict hospital mortality in unselected CICU patients with excellent discrimination.
Volume
8
Issue
17
First Page
013675
Last Page
013675
ISSN
2047-9980
Published In/Presented At
Jentzer, J. C., Anavekar, N. S., Bennett, C., Murphree, D. H., Keegan, M. T., Wiley, B., Morrow, D. A., Murphy, J. G., Bell, M. R., & Barsness, G. W. (2019). Derivation and Validation of a Novel Cardiac Intensive Care Unit Admission Risk Score for Mortality. Journal of the American Heart Association, 8(17), e013675. https://doi.org/10.1161/JAHA.119.013675
Disciplines
Medicine and Health Sciences
PubMedID
31462130
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article