Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU)
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Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). / Granholm, A.; Perner, A.; Krag, M.; Hjortrup, P. B.; Haase, N.; Holst, L. B.; Marker, S.; Collet, M. O.; Jensen, A. K.G.; Møller, M. H.
In: Acta Anaesthesiologica Scandinavica, Vol. 62, No. 3, 03.2018, p. 336-346.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU)
AU - Granholm, A.
AU - Perner, A.
AU - Krag, M.
AU - Hjortrup, P. B.
AU - Haase, N.
AU - Holst, L. B.
AU - Marker, S.
AU - Collet, M. O.
AU - Jensen, A. K.G.
AU - Møller, M. H.
PY - 2018/3
Y1 - 2018/3
N2 - Background: Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). Methods: We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism-corrected performance estimates. Results: The SMS-ICU comprises seven variables available in 99.5% of the patients: two numeric variables: age and lowest systolic blood pressure, and five dichotomous variables: haematologic malignancy/metastatic cancer, acute surgical admission and use of vasopressors/inotropes, respiratory support and renal replacement therapy. Discrimination (area under the receiver operating characteristic curve) was 0.72 (95% CI: 0.71-0.74), overall performance (Nagelkerke's R2) was 0.19 and calibration (intercept and slope) was 0.00 and 0.99, respectively. Optimism-corrected performance was similar to apparent performance. Conclusions: The SMS-ICU predicted 90-day mortality with reasonable and stable performance. If performance remains adequate after external validation, the SMS-ICU could prove a valuable tool for ICU clinicians and researchers because of its simplicity and expected very low number of missing values.
AB - Background: Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). Methods: We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism-corrected performance estimates. Results: The SMS-ICU comprises seven variables available in 99.5% of the patients: two numeric variables: age and lowest systolic blood pressure, and five dichotomous variables: haematologic malignancy/metastatic cancer, acute surgical admission and use of vasopressors/inotropes, respiratory support and renal replacement therapy. Discrimination (area under the receiver operating characteristic curve) was 0.72 (95% CI: 0.71-0.74), overall performance (Nagelkerke's R2) was 0.19 and calibration (intercept and slope) was 0.00 and 0.99, respectively. Optimism-corrected performance was similar to apparent performance. Conclusions: The SMS-ICU predicted 90-day mortality with reasonable and stable performance. If performance remains adequate after external validation, the SMS-ICU could prove a valuable tool for ICU clinicians and researchers because of its simplicity and expected very low number of missing values.
UR - http://www.scopus.com/inward/record.url?scp=85038250365&partnerID=8YFLogxK
U2 - 10.1111/aas.13048
DO - 10.1111/aas.13048
M3 - Journal article
C2 - 29210058
AN - SCOPUS:85038250365
VL - 62
SP - 336
EP - 346
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 3
ER -
ID: 187314392