title: A simple classification model for hospital mortality in patients with acute lung injury managed with lung protective ventilation.
abstract: OBJECTIVE
  Despite improvements in the care of critically ill patients, hospital mortality rate for acute lung injury remains high at approximately 40%. We developed a classification rule to stratify mechanically ventilated patients with acute lung injury according to hospital mortality and compared this rule with the Acute Physiology and Chronic Health Evaluation III prediction.
  
  
  METHODS
  We used data of 2,022 participants in Acute Respiratory Distress Syndrome Network trials to build a classification rule based on 54 variables collected before randomization.
  
  
  METHODS
  We used a classification tree approach to stratify patients according to hospital mortality using a training subset of 1800 participants and estimated expected prediction errors using tenfold crossvalidation. We validated our classification tree using a subset of 222 participants not included in model building and calculated areas under the receiver operating characteristic curves.
  
  
  RESULTS
  We identified combinations of age (>63 yrs), blood urea nitrogen (>15 mg/dL), shock, respiratory rate (>21 breaths/min), and minute ventilation (>13.9 L/min) as important predictors of hospital mortality at 90 days. The classification tree had a similar expected prediction error in the training set (28% vs. 26%; p = .18) and areas under the receiver operating characteristic curve in the validation set (0.71 vs. 0.73; p = .71) as did a model based on Acute Physiology and Chronic Health Evaluation III.
  
  
  CONCLUSIONS
  Our tree-based classification rule performed similarly to Acute Physiology and Chronic Health Evaluation III in stratifying patients according to hospital mortality, is simpler to use, contains risk factors that may be specific to acute lung injury, and identified minute ventilation as a potential novel predictor of death in patients with acute lung injury.
authors: Department of Surgery, Pulmonary and Critical Care Division, University of California, San Francisco, San Francisco, CA, USA.
authors: Lisa M
authors: LM
authors: Brown
authors: Carolyn S
authors: CS
authors: Calfee
authors: Michael A
authors: MA
authors: Matthay
authors: Roy G
authors: RG
authors: Brower
authors: B Taylor
authors: BT
authors: Thompson
authors: William
authors: W
authors: Checkley
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000367:Age Factors; D001806:Blood Urea Nitrogen; D002965:Classification; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012121:Respiration, Artificial / Q000401:mortality*; D056152:Respiratory Rate; D012307:Risk Factors; D012769:Shock / Q000401:mortality