MORTALITY PROBABILITY-MODELS (MPM-II) BASED ON AN INTERNATIONAL COHORT OF INTENSIVE-CARE UNIT PATIENTS

Objective.-To revise and update models in the Mortality Probability Mo del (MPM II) system to estimate the probability of hospital mortality among 19 124 intensive care unit (ICU) patients that can be used for q uality assessment within and among ICUs. Design and Setting.-Models de veloped and validated on consecutive admissions to adult medical and s urgical ICUs in 12 countries. Patients.-A total of 12 610 patients for model development, 6514 patients for model validation. Patients young er than 18 years and burn, coronary care, and cardiac surgery patients were excluded. Outcome Measure.-Vital status at hospital discharge. R esults.-The admission model, MPM0, contains 15 readily obtainable vari ables. In developmental and validation samples it calibrated well (goo dness-of-fit tests: P=.623 and P=.327, respectively, where a high P va lue represents good fit between observed and expected values) and disc riminated well (area under the receiver operating characteristic curve =0.837 and 0.824, respectively). The 24-hour model, MPM24 (developed o n 10 357 patients still in the ICU at 24 hours), contains five of the admission variables and eight additional variables easily ascertained at 24 hours. It also calibrated well (P=.764 and P=.231 in the develop mental and validation samples, respectively) and discriminated well (a rea under the receiver operating characteristic curve=0.844 and 0.836 in the developmental and validation samples, respectively). Conclusion s.-Among severity systems for intensive care patients, the MPM0 is the only model available for use at ICU admission. Both MPM0 and MPM2, ar e useful research tools and provide important clinical information whe n used alone or together.