Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.17/1429
Título: Modeling in-Hospital Patient Survival During the First 28 Days After Intensive Care Unit Admission: a Prognostic Model for Clinical Trials in General Critically Ill Patients
Autor: Moreno, R
Metnitz, P
Metnitz, B
Bauer, P
Afonso de Carvalho, S
Hoechtl, A
SAPS 3 Investigators
Palavras-chave: Ensaios Clínicos Como Assunto
Estado Terminal
Mortalidade Hospitalar
Unidades de Cuidados Intensivos
Modelos Estatísticos
Avaliação de Risco
Índice de Gravidade da Doença
Factores de Tempo
Data: 2008
Editora: Elsevier
Citação: J Crit Care. 2008 Sep;23(3):339-48
Resumo: OBJECTIVE: The objective of the study was to develop a model for estimating patient 28-day in-hospital mortality using 2 different statistical approaches. DESIGN: The study was designed to develop an outcome prediction model for 28-day in-hospital mortality using (a) logistic regression with random effects and (b) a multilevel Cox proportional hazards model. SETTING: The study involved 305 intensive care units (ICUs) from the basic Simplified Acute Physiology Score (SAPS) 3 cohort. PATIENTS AND PARTICIPANTS: Patients (n = 17138) were from the SAPS 3 database with follow-up data pertaining to the first 28 days in hospital after ICU admission. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The database was divided randomly into 5 roughly equal-sized parts (at the ICU level). It was thus possible to run the model-building procedure 5 times, each time taking four fifths of the sample as a development set and the remaining fifth as the validation set. At 28 days after ICU admission, 19.98% of the patients were still in the hospital. Because of the different sampling space and outcome variables, both models presented a better fit in this sample than did the SAPS 3 admission score calibrated to vital status at hospital discharge, both on the general population and in major subgroups. CONCLUSIONS: Both statistical methods can be used to model the 28-day in-hospital mortality better than the SAPS 3 admission model. However, because the logistic regression approach is specifically designed to forecast 28-day mortality, and given the high uncertainty associated with the assumption of the proportionality of risks in the Cox model, the logistic regression approach proved to be superior.
Peer review: yes
URI: http://hdl.handle.net/10400.17/1429
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