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J Crit Care. 2015 Jun;30(3):654.e1-7. doi: 10.1016/j.jcrc.2015.01.011. Epub 2015 Jan 14.

Evolution and prognosis of long intensive care unit stay patients suffering a deterioration: A multicenter study.

Collaborators (95)

Saldaña González FJ, Galván Martín JM, Monterroso R, Rubio Quiñones J, Dayz Alersi R, Mayor García DM, Rodríguez Higueras I, Barranco Ruiz M, Sánchez Román JA, Suárez Pinilla MÁ, López Núñez C, García Ronquillo JC, Zamora Elson M, Torralba Allué JC, Tirado Anglés G, Poyo-Guerrero Lahoz R, Forteza Cañelas C, Santacreu R, Sisón Heredia M, Parrilla Toribio D, Rodríguez Ramos ST, Cordero Vallejo M, Castellanos Ortega Á, Bueno González A, Villegas del Ojo J, Benito Puncel C, Sánchez Rodríguez P, Sala Scarbay CJ, Álvarez Pérez TL, Tarancón Maján FC, González M, Cicuéndez Ávila R, Amador Amérigo J, Miró Andreu G, Mas A, Silva A, Zavala E, Rubio Sanchiz O, Basas M, León Vallés M, Iglesias Moles S, Ibáñez M, Cherta I, García Ramos MJ, Minaya González F, Gil Pérez NM, Gómez Canosa MS, Freita Ramos S, Astola Hidalgo I, Mourelo Fariña M, Saborido Paz E, Pereira Loureiro MÁ, García Martul M, Rodríguez Fernández MJ, Bravo Doviso JV, Martín Delgado MC, Estébanez Montiel MB, Gómez García JM, Arias Sarmiento E, Andino Ruiz R, García Costas M, Leal Micharet A, Honrubia Fernández T, Enciso Calderón MV, Hernández-Tejedor A, Díaz Díaz D, Hernández G, García de Lorenzo A, Gallardo Álvarez JA, Córdoba Sánchez ÁL, Cambronero Galache JA, Fernandez Simón I, Valdivia de la Fuente M, Lacoma F, Prieto del Portillo I, López Martínez A, Herrera Para L, Moreno Aliaga S, Susarte Juliá CM, Martínez Martínez M, Monedero P, Barber Ansón M, Regidor Sanz E, Macaya Redín L, Domezain del Campo M, Manzano Ramírez A, Poveda Hernández Y, Castedo González JF, Mintegui Malcorra I, Elosegui Plaza I, Monzón Marín JL, Martínez Camarero L, Palomo Navarro M, Llamas Álvarez A, Kot P.

Author information

1
Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Madrid, Spain. Electronic address: albertohmed@hotmail.com.
2
Unidad de Cuidados Intensivos, Hospital de Barcelona SCIAS, 08034 Barcelona, Spain. Electronic address: 10654lcp@comb.cat.
3
Unidad de Cuidados Intensivos, Hospital Universitario de Torrejón, 28850 Torrejón de Ardoz, Madrid, Spain. Electronic address: mmartin@torrejonsalud.com.
4
Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Madrid, Spain. Electronic address: alealmicharet@gmail.com.
5
Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Madrid, Spain. Electronic address: aalgora@fhalcorcon.es.

Abstract

PURPOSE:

The prognosis of a patient who deteriorates during a prolonged intensive care unit (ICU) stay is difficult to predict. We analyze the prognostic value of the serialized Sequential Organ Failure Assessment (SOFA) score and other variables in the early days after a complication and to build a new predictive score.

MATERIALS AND METHODS:

EPIPUSE (Evolución y pronóstico de los pacientes con ingreso prolongado en UCI que sufren un empeoramiento, Evolution and prognosis of long intensive care unit stay patients suffering a deterioration) study is a prospective, observational study during a 3-month recruitment period in 75 Spanish ICUs. We focused on patients admitted in the ICU for 7 days or more with complications of adverse events that involve organ dysfunction impairment. Demographics, clinical variables, and serialized SOFA after a supervening clinical deterioration were recorded. Univariate and multivariate analyses were performed, and a predictive model was created with the most discriminating variables.

RESULTS:

We included 589 patients who experienced 777 cases of severe complication or adverse event. The entire sample was randomly divided into 2 subsamples, one for development purposes (528 cases) and the other for validation (249 cases). The predictive model maximizing specificity is calculated by minimum SOFA + 2 * cardiovascular risk factors + 2 * history of any oncologic disease or immunosuppressive treatment + 3 * dependence for basic activities of daily living. The area under the receiver operating characteristic curve is 0.82. A 14-point cutoff has a positive predictive value of 100% (92.7%-100%) and negative predictive value of 51% (46.4%-55.5%) for death.

CONCLUSIONS:

EPIPUSE model can predict mortality with a specificity and positive predictive value of 99% in some groups of patients.

KEYWORDS:

Bioethics; Decision making; Life-sustaining treatment; Multiple organ dysfunction syndrome; Organ dysfunction scores

PMID:
25656920
DOI:
10.1016/j.jcrc.2015.01.011
[Indexed for MEDLINE]

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