ICU ADMISSION SCORE FOR PREDICTING MORBIDITY AND MORTALITY RISK AFTERCORONARY-ARTERY BYPASS-GRAFTING

Background. This study was performed to develop an intensive care unit (ICU) admission risk score based on preoperative condition and intrao perative events. This score provides a tool with which to judge the ef fects of ICU quality of care on outcome. Methods. Data were collected prospectively on 4,918 patients (study group n = 2,793 and a validatio n data set n = 2,125) undergoing coronary artery bypass grafting alone or combined with a valve or carotid procedure between January 1, 1993 , and March 31, 1995. Data were analyzed by univariate and multiple lo gistic regression with the end points of hospital mortality and seriou s ICU morbidity (stroke, low cardiac output, myocardial infarction, pr olonged ventilation, serious infection, renal failure, or death). Resu lts. Eight risk factors predicted hospital mortality at ICU admission, and these factors and five others predicted morbidity. A clinical sco re, weighted equally for morbidity and mortality, was developed. All m odels fit according to the Hosmer-Lemeshow goodness-of-fit test. This score applies equally well to patients undergoing isolated coronary ar tery bypass grafting. Conclusions. This model is complementary to our previously reported preoperative model, allowing the process of ICU ca re to be measured independent of the operative care. Sequential scorin g also allows updated prognoses at different points in the continuum o f care. (C) 1997 by The Society of Thoracic Surgeons.