Lamarche et al reported a model for a patient admitted to the intensive care unit (ICU) following cardiac surgery. The authors are from Montreal Heart Institute, Provincial Health Services Authority, St. Paul's Hospital and University of British Columbia.
Patient selection: adult
Outcome: 30-day mortality
Parameters:
(1) procedure
(2) age in years
(3) sex
(4) surgical acuity
(5) coronary artery disease
(6) pulmonary hypertension
(7) peripheral vascular disease
(8) eGFR
(9) diabetes mellitus
(10) history of peptic ulcer or GI bleed
(11) alcohol abuse
(12) blood products
(13) intraoperative intra-aortic balloon pump (IABP)
(14) VAD or ECMO
(15) intraoperative complication
(16) inotrope
(17) cardiopulmonary bypass time in hours
|
Parameters |
Findings |
Points |
|
procedure |
CABG only |
0 |
|
|
ascending aortic procedure |
0.7711 |
|
|
CABG + single valve |
0.3322 |
|
|
CABG + multiple valves |
0.4669 |
|
|
single valve |
0.6825 |
|
|
multiple valves |
1.1051 |
|
age |
|
0.5549*(age)/10 |
|
sex |
male |
0 |
|
|
female |
0.3704 |
|
surgical acuity |
emergency |
1.4929 |
|
|
urgent |
0.4966 |
|
|
elective |
0 |
|
coronary artery disease |
left main stenosis |
0.4198 |
|
|
3-vessel disease |
0.4198 |
|
|
other or none |
0 |
|
pulmonary hypertension |
no |
0 |
|
|
yes |
0.4976 |
|
peripheral vascular disease |
no |
0 |
|
|
yes |
0.434 |
|
eGFR |
>= 60 |
0 |
|
|
15 to 59 |
0.2923 |
|
|
< 15 (renal failure) |
0.4521 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
0.2732 |
|
peptic ulcer or GI bleed |
no |
0 |
|
|
yes |
0.5183 |
|
alcohol abuse |
no |
0 |
|
|
yes |
0.5647 |
|
blood products |
refusal |
1.8595 |
|
|
packed cells |
0.3158 |
|
|
other |
0 |
|
IABP |
no |
0 |
|
|
yes |
0.977 |
|
VAD or ECMO |
no |
0 |
|
|
yes |
1.6479 |
|
intraoperative complication |
no |
0 |
|
|
yes |
0.9199 |
|
inotrope |
yes |
0.5315 |
|
|
no |
0 |
|
high dose vasopressors |
yes |
0.6204 |
|
|
no |
0 |
|
CPB time |
|
0.2442 * (hours) |
where:
• Inotrope: adrenaline, dobutamine, milrinone, or high-dose dopamine leaving the operating room.
• High-dose vasopressors: norepinephrine > 10 µg/min or more than one vasopressor used.
X =
= SUM(points for all of the parameters) - 10.2028
probability of 30-day mortality =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.86.
Specialty: Critical Care, Surgery, general
