A Simplified Risk Scoring System to Predict Mortality in Cardiovascular Intensive Care Unit

Abstract

Background Cardiovascular intensive care unit (CICU) is an area with high mortality rates globally. The prediction of inpatients mortality risk at CICU needs a simplified scoring systems. Hence, this study aims to analyze the predictors for in-hospital mortality of patients whom hospitalized at CICU of Sardjito General Hospital Yogyakarta and to create a mortality risk score based on the results of this analysis. Methods Data were obtained from SCIENCE (Sardjito Cardiovascular Intensive Care) registry. Outcomes of 595 consecutive patients (mean age 59.92 ± 13.0 years) from January to November 2017 were recorded retrospectively. Demography, risk factor, comorbidities, laboratory result and other examinations were analyzed by multivariate logistic regression to create two models of scoring system (probability and cut-off model) to predict in-hospital mortality of any cause. Results A total of 595 subjects were included in this research; death was found in 55 patients (9.2%). Multiple logistic regression analysis showed some variables that became independent predictor of mortality, i.e. age ≥ 60 years, pneumonia, the use of ventilator machine, and increased of serum glutamate-pyruvate transaminase level, an increased of creatinine level and an ejection fraction < 40%. Receiver operating characteristic (ROC) curve analysis showed a cut-off model scoring system with score 3 to 9 predicting mortality compared to score 0 - 2. This model yielded sensitivity of 80% and specificity 74%. While the probability scoring system (score 0 to 9) showed that the higher the score, the higher the mortality probability (e.g. the mortality of patient with score 2 is 5.27%; while the mortality of patient with score 8 is 87.5%). Conclusions Scoring system derived from this study can be used to predict the in-hospital mortality of patients whom hospitalized in our CICU and show a favorable sensitivity and specificity result.

Comparison of Pediatric Sequential Organ Failure Assessment and Pediatric Risk of Mortality III Score as Mortality Prediction in Pediatric Intensive Care Unit

“…An ideal scoring system would be accurate, easy to use, and simple, as well as minimally intrusive and low-cost. However, no scoring system is flawless, and each one has its own set of limitations, which is why studies are being conducted to enhance accuracy, verify existing ones, and develop new ones [15,16]. Therefore, the aim of our study was to assess and compare the diagnostic accuracy of the PRISM III and the p-SOFA for the prediction of mortality in critically ill children.…”

First 24-h Sardjito Cardiovascular Intensive Care (SCIENCE) admission risk score to predict mortality in cardiovascular intensive care unit (CICU)

“…During this time period, only data from the first 24 h of CICU admission were included. Based on the results of a previous study, 8 the study will need to recruit minimum of 125 subjects with a type I error of 0.05 and with at least 80% power of this study.…”

In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia

“…Acute coronary syndrome (ACS) constituted the highest proportion of cardiovascular disease in Indonesia. Bagaswoto, et al, observed in SCIENCE (Sardjito Cardiovascular Intensive Care), that from 595 patients coming to the intensive care unit around January to November 2017, 69.9% were diagnosed with ACS and had an in-hospital mortality rate of 9.2% [ 11 ]. In a separate research conducted by Qanitha et al, it was revealed that approximately 76% of individuals within the coronary artery disease (CAD) population were afflicted by ACS during their study period spanning from February 2013 to December 2014 [ 12 ].…”