Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study

Abstract

Introduction The aim of this study was to evaluate the performance of five general severity-of-illness scores (Acute Physiology and Chronic Health Evaluation II and III-J, the Simplified Acute Physiology Score II, and the Mortality Probability Models at admission and at 24 hours of intensive care unit [ICU] stay), and to validate a specific score -the ICU Cancer Mortality Model (CMM) -in cancer patients requiring admission to the ICU. Methods A prospective observational cohort study was performed in an oncological medical/surgical ICU in a Brazilian cancer centre. Data were collected over the first 24 hours of ICU stay. Discrimination was assessed by area under the receiver operating characteristic curves and calibration was done using Hosmer-Lemeshow goodness-of-fit H-tests. Results A total of 1257 consecutive patients were included over a 39-month period, and 715 (56.9%) were scheduled surgical patients. The observed hospital mortality was 28.6%. Two performance analyses were carried out: in the first analysis all patients were studied; and in the second, scheduled surgical patients were excluded in order to better compare CMM and general prognostic scores. The results of the two analyses were similar. Discrimination was good for all of the six studied models and best for Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation III-J. However, calibration was uniformly insufficient (P < 0.001). General scores significantly underestimated mortality (in comparison with the observed mortality); this was in contrast to the CMM, which tended to overestimate mortality. Conclusion None of the model scores accurately predicted outcome in the present group of critically ill cancer patients. In addition, there was no advantage of CMM over the other general models.

Predicting Hospital Mortality in Critically Ill Cancer Patients according to Acute Kidney Injury Severity

“…Several prognostic scores are available for use in critically ill patients, and general prognostic models generally underestimate the risk of mortality in critically ill cancer patients [30,31]. Few specific scores have been developed for this specific population.…”

“…Few specific scores have been developed for this specific population. The Cancer Mortality Model was developed in 1998 [32], demonstrating a good discriminatory capacity; however, subsequent studies using general scores such as SAPS II showed a better performance when predicting mortality [30]. …”

Performance of Three Prognostic Models in Patients with Cancer in Need of Intensive Care in a Medical Center in China

“…Statistical analysis was performed in the same way as Soares’ et al [ 13 ]. In short, validation of the prognostic scores was performed using standard tests to measure discrimination and calibration for each of the predictive models.…”

Admission of critically ill patients with cancer to the ICU: many uncertainties remain

“…It should be emphasised that precision in prognosis is crucially important in ensuring that patients with a reasonable prospect of recovery will not be deprived of ICU admission, but also that patients along with their families will not undergo any unnecessary suffering should there be a low chance of recovery. Emphasis should be given to the fact that the current prognostic models used for all ICU patients have been found to be inaccurate in predicting outcome in patients with cancer, 19 whereas clinical judgement alone fails to predict an accurate prognosis. 20 In fact, the absence of reliable predictors of outcome at the time of ICU admission has led some investigators to suggest an ‘ICU trial’ consisted of an unrestricted ICU admission policy with full code management, for a limited period of time, followed by a reappraisal of the level of care afterwards.…”

“…Current clinical research on critically ill patients with cancer is focused on factors predicting short-term (ICU or hospital) mortality, 5 6 19 23–25 whereas studies on long-term outcomes have been mainly restricted to specific subgroups of patients. 7 12 26–28 Although in the majority of studies, short-term survival after ICU treatment has been reported to be higher than 50%, 5 7 8 15 18 23 25 long-term survival, quality of life and quality-adjusted life year expectancy have been reported to be limited.…”