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Crit Care Med. 2007 Mar;35(3):827-35.

Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III).

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  • 1Critical Care Division, Baystate Medical Center, Springfield, MA, USA.

Abstract

OBJECTIVE:

To update the Mortality Probability Model at intensive care unit (ICU) admission (MPM0-II) using contemporary data.

DESIGN:

Retrospective analysis of data from 124,855 patients admitted to 135 ICUs at 98 hospitals participating in Project IMPACT between 2001 and 2004. Independent variables considered were 15 MPM0-II variables, time before ICU admission, and code status. Univariate analysis and multivariate logistic regression were used to identify risk factors associated with hospital mortality.

SETTING:

One hundred thirty-five ICUs at 98 hospitals.

PATIENTS:

Patients in the Project IMPACT database eligible for MPM0-II scoring.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Hospital mortality rate in the current data set was 13.8% vs. 20.8% in the MPM0-II cohort. All MPM0-II variables remained associated with mortality. Clinical conditions with high relative risks in MPM0-II also had high relative risks in MPM0-III. Gastrointestinal bleeding is now associated with lower mortality risk. Two factors have been added to MPM0-III: "full code" resuscitation status at ICU admission, and "zero factor" (absence of all MPM0-II risk factors except age). Seven two-way interactions between MPM0-II variables and age were included and reflect the declining marginal contribution of acute and chronic medical conditions to mortality risk with increasing age. Lead time before ICU admission and pre-ICU location influenced individual outcomes but did not improve model discrimination or calibration. MPM0-III calibrates well by graphic comparison of actual vs. expected mortality, overall standardized mortality ratio (1.018; 95% confidence interval, 0.996-1.040) and a low Hosmer-Lemeshow goodness-of-fit statistic (11.62; p = .31). The area under the receiver operating characteristic curve was 0.823.

CONCLUSIONS:

MPM0-II risk factors remain relevant in predicting ICU outcome, but the 1993 model significantly overpredicts mortality in contemporary practice. With the advantage of a much larger sample size and the addition of new variables and interaction effects, MPM0-III provides more accurate comparisons of actual vs. expected ICU outcomes.

Comment in

PMID:
17255863
[PubMed - indexed for MEDLINE]
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