title: Outcome in medical intensive care unit patients requiring abdominal surgery: prospective validation of a risk classification system.
abstract: To prospectively validate a previously developed two-factor logistic regression model as a predictor of mortality, we studied its effectiveness in predicting outcome for patients in medical intensive care units (ICUs) who had surgical laparotomy. A high-risk classification was assigned to patients with an Organ System Failure Index (OSFI) > or = 3 or an APACHE (Acute Physiology and Chronic Health Evaluation) II score > 18 within 24 hours of surgery. The in-hospital mortality rate of surgical patients classified as high risk (n = 32) was significantly greater than that of surgical patients classified as low risk (n = 42) (62.5% versus 9.5%; relative risk, 6.6; 95% confidence interval, 2.5 to 17.3). Mortality after surgery correlated with presence or absence of the two variables from the logistic regression model: neither present, 9.5%; APACHE II > 18 present, 68.0%; OSFI > or = 3 present, 75.0%; both present, 88.2%. We showed that a two-factor risk classification at the time of surgical evaluation can be used to stratify medical ICU patients according to risk of in-hospital mortality.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, St. Louis, Mo 63110, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Kollef
authors.forename: B T
authors.initials: BT
authors.lastname: Allen
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome