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
M. Guiguet et al., 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, Critical care medicine, 26(3), 1998, pp. 488-493
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.