SEVERITY-OF-ILLNESS SCORES FOR NEUTROPENIC CANCER-PATIENTS IN AN INTENSIVE-CARE UNIT - WHICH IS THE BEST PREDICTOR - DO MULTIPLE ASSESSMENTTIMES IMPROVE THE PREDICTIVE VALUE

Objectives: To use three severity of illness scores to estimate the pr obability of hospital mortality among patients with cancer and neutrop enia; to compare the performance of these scores, calculated at admiss ion to an intensive care unit (ICU); and to test the improvement in es timation obtained by taking into account the first 72 hr period. Desig n: Collection of data for every neutropenic patient hospitalized in th e ICU during a 4-yr period. Setting: A comprehensive cancer center. Pa tients: Ninety four patients were neutropenic at ICU admission. Their vital status was measured at hospital discharge, Measurements and Main Results: The new Simplified Acute Physiology Score (SAPS) II improved the estimation of hospital mortality compared with the original SAPS score, Using a simple score based on the number of acute organ system failures (OSFs) to classify the patients, good discrimination between survivors and nonsurvivors was observed (area under the receiver opera ting characteristic curves, 79 +/- 5 [SD] %), The relationship between successive scores and outcome was explored using recursive partitioni ng, Patients were first classified according to their OSF value on the first day of hospitalization in the ICU with a cutoff of two organ fa ilures, and classification was then improved by taking into account th e OSF score on the third day. Conclusions: For cancer patients hospita lized in an ICU for a neutropenic episode, the severity of illness and the risk of death can be accurately assessed by the SAPS II score and the number of acute organ failures at admission, The OSF values on th e first and third days of hospitalization both provided information, a llowing the classification of patients into groups with different prob abilities of hospital mortality.