title: Seven-day mortality can be predicted in medical patients by blood pressure, age, respiratory rate, loss of independence, and peripheral oxygen saturation (the PARIS score): a prospective cohort study with external validation.
abstract: BACKGROUND
  Most existing risk stratification systems predicting mortality in emergency departments or admission units are complex in clinical use or have not been validated to a level where use is considered appropriate. We aimed to develop and validate a simple system that predicts seven-day mortality of acutely admitted medical patients using routinely collected variables obtained within the first minutes after arrival.
  
  
  RESULTS
  This observational prospective cohort study used three independent cohorts at the medical admission units at a regional teaching hospital and a tertiary university hospital and included all adult (≥ 15 years) patients. Multivariable logistic regression analysis was used to identify the clinical variables that best predicted the endpoint. From this, we developed a simplified model that can be calculated without specialized tools or loss of predictive ability. The outcome was defined as seven-day all-cause mortality. 76 patients (2.5%) met the endpoint in the development cohort, 57 (2.0%) in the first validation cohort, and 111 (4.3%) in the second. Systolic blood Pressure, Age, Respiratory rate, loss of Independence, and peripheral oxygen Saturation were associated with the endpoint (full model). Based on this, we developed a simple score (range 0-5), ie, the PARIS score, by dichotomizing the variables. The ability to identify patients at increased risk (discriminatory power and calibration) was excellent for all three cohorts using both models. For patients with a PARIS score ≥ 3, sensitivity was 62.5-74.0%, specificity 85.9-91.1%, positive predictive value 11.2-17.5%, and negative predictive value 98.3-99.3%. Patients with a score ≤ 1 had a low mortality (≤ 1%); with 2, intermediate mortality (2-5%); and ≥ 3, high mortality (≥ 10%).
  
  
  CONCLUSIONS
  Seven-day mortality can be predicted upon admission with high sensitivity and specificity and excellent negative predictive values.
authors: Department of Medicine, Sydvestjysk Sygehus, Esbjerg, Denmark; Centre South Western Denmark, Institute of Regional Health Research-University of Southern Denmark, Esbjerg, Denmark.
authors: Mikkel
authors: M
authors: Brabrand
authors: Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
authors: Annmarie Touborg
authors: AT
authors: Lassen
authors: Department of Medicine, Sydvestjysk Sygehus, Esbjerg, Denmark; Centre South Western Denmark, Institute of Regional Health Research-University of Southern Denmark, Esbjerg, Denmark.
authors: Torben
authors: T
authors: Knudsen
authors: Reseach Unit of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark.
authors: Jesper
authors: J
authors: Hallas
mesh_terms: D000203:Activities of Daily Living; D001794:Blood Pressure; D006801:Humans; D008962:Models, Theoretical; D009026:Mortality; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D012119:Respiration
chemical_list: D010100:Oxygen