title: Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care.
abstract: BACKGROUND
  Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Invasive Ventilation (NIV). The limited number of prognostic studies in this population support the need of mortality prediction evaluation in this context.
  
  
  OBJECTIVE
  The objective of this study is to analyze the performance of Simplified Acute Physiology Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for new variables that could be useful to customize these scores, in order to improve mortality prediction.
  
  
  METHODS
  Cohort study with prospectively collected data from all patients admitted to a single center ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality rates were calculated. Discrimination and calibration were evaluated by calculating the area under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow goodness of fit test for the models, respectively. Binary logistic regression was used to identify new variables to customize the scores for mortality prediction in this setting.
  
  
  METHODS
  The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists from April 2006 to December 2013.
  
  
  RESULTS
  The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio (SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppression, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic acid, pCO2 and haemoglobin levels showed better discrimination than old scores with similar calibration power.
  
  
  CONCLUSIONS
  These results suggest that SAPS II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate care.
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Martinez-Urbistondo
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Alegre
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Carmona-Torre
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Huerta
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Fernandez-Ros
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
authors.forename: Manuel Fortún
authors.initials: MF
authors.lastname: Landecho
authors.affiliation: Clínica Universidad de Navarra, Information Technology, Pamplona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Mouriz
authors.affiliation: Clínica Universidad de Navarra, Division of Biostatistics, Research Support Service, Central Clinical Trials Unit, Pamplona, Spain; Department of Preventive Medicine and Public Health, Medical School, Universidad de Navarra, Pamplona, Spain; Epidemiology and Public Health Area, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
authors.forename: Jorge M
authors.initials: JM
authors.lastname: Núñez-Córdoba
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: García
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Quiroga
authors.affiliation: Clínica Universidad de Navarra, Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Pamplona, Spain.
authors.forename: Juan Felipe
authors.initials: JF
authors.lastname: Lucena
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D063087:Noninvasive Ventilation; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy*