Heyland et al developed a model for predicting the performance status of an elderly adult 1 year after admission to the intensive care unit (ICU). This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Canada and enrolled as Canadian Researchers at the End of Life Network.
Patient selection: adult >= 80 years of age admitted to the ICU for >= 24 hours with a medical or urgent surgical diagnosis
Outcome: Palliative Performance Scale (PPS) >= 60 at 1 year
Parameters based on admission data:
(1) baseline Palliative Performance Scale (PPS), from 0 to 100
(2) gender
(3) marital status
(4) APACHE 2 score
(5) Charlson Comorbidity Index (CCI)
(6) primary diagnosis
(7) clinical frailty scale (Rockwood et al, from 1 to 7)
|
Parameter
|
Finding
|
Points
|
|
gender
|
female
|
0
|
|
|
male
|
-0.682
|
|
marital status
|
married
|
0.466
|
|
|
not married
|
0
|
|
primary diagnosis
|
stroke
|
-1.21
|
|
|
CABG or valve replacement
|
2.14
|
|
|
other
|
0
|
|
Parmeter
|
Points
|
|
baseline PPS
|
(0.562 * (PPS) / 30)
|
|
APACHE 2
|
(-0.649 * (APACHE 2) / 9)
|
|
Charlson comorbidity index
|
(-0.534 * (CCI) / 2)
|
|
clinical frailty scale
|
(-0.874 * (CFS) / 2)
|
where:
• The point assignment is based on LN(odds ratio).
X =
= SUM(points for all 7 parameters) + 1.63
probability of PPS >= 60 at 1 year =
= 1 / (1 + EXP((-1) * X))
Performance:
• The reported area under the ROC curve was 0.81.
