ICU admission score for predicting morbidity and mortality risk after coronary artery bypass grafting.
BACKGROUND
This study was performed to develop an intensive care unit (ICU) admission risk score based on preoperative condition and intraoperative events. This score provides a tool with which to judge the effects of ICU quality of care on outcome.


METHODS
Data were collected prospectively on 4,918 patients (study group n = 2,793 and a validation data set n = 2,125) undergoing coronary artery bypass grafting alone or combined with a valve or carotid procedure between January 1, 1993, and March 31, 1995. Data were analyzed by univariate and multiple logistic regression with the end points of hospital mortality and serious ICU morbidity (stroke, low cardiac output, myocardial infarction, prolonged ventilation, serious infection, renal failure, or death).


RESULTS
Eight risk factors predicted hospital mortality at ICU admission, and these factors and five others predicted morbidity. A clinical score, weighted equally for morbidity and mortality, was developed. All models fit according to the Hosmer-Lemeshow goodness-of-fit test. This score applies equally well to patients undergoing isolated coronary artery bypass grafting.


CONCLUSIONS
This model is complementary to our previously reported preoperative model, allowing the process of ICU care to be measured independent of the operative care. Sequential scoring also allows updated prognoses at different points in the continuum of care.
Higgins
T L
TL
Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Ohio 44195, USA.
Estafanous
F G
FG
Loop
F D
FD
Beck
G J
GJ
Lee
J C
JC
Starr
N J
NJ
Knaus
W A
WA
Cosgrove
D M
DM
D001026:Coronary Artery Bypass / Q000401:mortality*; D003325:Coronary Care Units; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index