Fortis et al reported a "simplified" critical illness scoring system (CISSS) for evaluating a patient in the intensive care unit. The authors are from Iowa City VA Health Care System and the University of Iowa.
Patient selection: adult in the intensive care unit (ICU)
Outcome: 30-day mortality
Parameters:
(1) age in years
(2) comorbidities (AIDS, liver disease, malignancy)
(3) heart rate in beats per minute
(4) mean arterial pressure in mm Hg
(5) temperature in °C
(6) breathing (respiratory rate in breaths per minute or mechanical support)
(7) hematocrit in percent
(8) white blood cell count per microliter
(9) serum creatinine in mg/dL
(10) serum sodium in mmol/L
(11) serum bicarbonate in mmol/L
(12) serum glucose in mg/dL
(13) serum albumin in g/dL
(14) serum total bilirubin in mg/dL
(15) surgery
|
Parameter |
Finding |
Points |
|
age in years |
<= 50 years |
0 |
|
|
51 to 60 years |
6 |
|
|
61 to 70 years |
10 |
|
|
71 to 80 years |
16 |
|
|
> 80 years |
22 |
|
AIDS |
no |
0 |
|
|
yes |
6 |
|
liver disease |
no |
0 |
|
|
cirrhosis |
3 |
|
|
hepatic failure |
7 |
|
cancer |
none |
0 |
|
|
leukemia |
5 |
|
|
lymphoma |
7 |
|
|
metastatic cancer |
14 |
|
|
localized cancer |
0 |
|
heart rate |
<= 55 beats per minute |
0 |
|
|
56 to 70 |
1 |
|
|
71 to 100 |
3 |
|
|
> 100 |
5 |
|
mean arterial pressure |
<= 50 mm Hg |
5 |
|
|
51 to 80 mm Hg |
3 |
|
|
81 to 90 mm Hg |
1 |
|
|
> 90 mm Hg |
0 |
|
temperature |
<= 35.5 °C |
5 |
|
|
35.6 to 36°C |
3 |
|
|
36.1 to 37°C |
1 |
|
|
> 37°C |
0 |
|
breathing |
spontaneous, <= 12 |
0 |
|
|
spontaneous, 13 to 20 |
2 |
|
|
spontaneous, 21 to 27 |
5 |
|
|
spontaneous, > 27 |
8 |
|
|
ventilator, <= 12 |
10 |
|
|
ventilator, 13 to 20 |
13 |
|
|
ventilator, 21 to 27 |
13 |
|
|
ventilator, > 27 |
15 |
|
hematocrit |
<= 35 percent |
1 |
|
|
35.1 to 41 percent |
0 |
|
|
> 41 percent |
1 |
|
WBC per microliter |
<= 4,000 per µL |
4 |
|
|
4,001 to 9,000 |
0 |
|
|
9,001 to 16,000 |
2 |
|
|
> 16,000 |
4 |
|
serum creatinine |
<= 0.7 mg/dL |
2 |
|
|
0.71 to 1 mg/dL |
0 |
|
|
1.01 to 1.7 mg/dL |
1 |
|
|
> 1.7 mg/dL |
4 |
|
serum sodium |
<= 135 mmol/L |
2 |
|
|
136 to 140 mmol/L |
0 |
|
|
141 to 145 mmol/L |
1 |
|
|
> 145 mmol/L |
6 |
|
serum bicarbonate |
<= 9 mmol/L |
10 |
|
|
9.1 to 20 mmol/L |
6 |
|
|
20.1 to 23 mmol/L |
2 |
|
|
23.1 to 29 mmol/L |
0 |
|
|
> 29 mmol/L |
3 |
|
serum glucose |
<= 50 mg/dL |
4 |
|
|
50.1 to 80 mg/dL |
2 |
|
|
> 80 mg/dL |
0 |
|
serum albumin |
<= 2 g/dL |
13 |
|
|
2.01 to 2.5 g/dL |
8 |
|
|
2.6 to 3.1 g/dL |
5 |
|
|
3.2 to 3.5 g/dL |
1 |
|
|
> 3.5 g/dL |
0 |
|
serum total bilirubin |
<= 1.5 mg/dL |
0 |
|
|
1.51 to 2.0 mg/dL |
3 |
|
|
2.01 to 3.9 mg/dL |
5 |
|
|
3.91 to 7.3 |
8 |
|
|
> 7.3 |
13 |
|
surgery |
no |
9 |
|
|
yes |
0 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 143
value of X =
= (0.1000549 * (score)) - 7.0063219
probability of 30-day mortality =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.85.
Specialty: Critical Care
