title: Development of an open-heart intraoperative risk scoring model for predicting a prolonged intensive care unit stay.
abstract: BACKGROUND
  Based on a pilot study with 34 patients, applying the modified sequential organ failure assessment (SOFA) score intraoperatively could predict a prolonged ICU stay, albeit with only 4 risk factors. Our objective was to develop a practicable intraoperative model for predicting prolonged ICU stay which included more relevant risk factors.
  
  
  METHODS
  An extensive literature review identified 6 other intraoperative risk factors affecting prolonged ICU stay. Another 168 patients were then recruited for whom all 10 risk factors were extracted and analyzed by logistic regression to form the new prognostic model.
  
  
  RESULTS
  The multivariate logistic regression analysis retained only 6 significant risk factors in the model: age ≥ 60 years, PaO2/FiO2 ratio ≤ 200 mmHg, platelet count ≤ 120,000/mm(3), requirement for inotrope/vasopressor ≥ 2 drugs, serum potassium ≤ 3.2 mEq/L, and atrial fibrillation grading ≥ 2. This model was then simplified into the Open-Heart Intraoperative Risk (OHIR) score, comprising the same 6 risk factors for a total score of 7-a score of ≥ 3 indicating a likely prolonged ICU stay (AUC for ROC of 0.746).
  
  
  CONCLUSIONS
  We developed a new, easy to calculate OHIR scoring system for predicting prolonged ICU stay as early as 3 hours after CPB. It comprises 6 risk factors, 5 of which can be manipulated intraoperatively.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Sirirat
authors.initials: S
authors.lastname: Tribuddharat
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Thepakorn
authors.initials: T
authors.lastname: Sathitkarnmanee
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Kriangsak
authors.initials: K
authors.lastname: Ngamsangsirisup
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
authors.forename: Somrat
authors.initials: S
authors.lastname: Charuluxananan
authors.affiliation: Clinical Epidemiology Unit (CEU), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Cameron P
authors.initials: CP
authors.lastname: Hurst
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Suparit
authors.initials: S
authors.lastname: Silarat
authors.affiliation: Department of Clinical Immunology, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Ganjana
authors.initials: G
authors.lastname: Lertmemongkolchai
mesh_terms: D013504:Cardiovascular Surgical Procedures; D003710:Demography; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity