Establishment and Validation of GV-SAPS II Scoring System for Non-Diabetic Critically Ill Patients.
OBJECTIVE
Recently, glucose variability (GV) has been reported as an independent risk factor for mortality in non-diabetic critically ill patients. However, GV is not incorporated in any severity scoring system for critically ill patients currently. The aim of this study was to establish and validate a modified Simplified Acute Physiology Score II scoring system (SAPS II), integrated with GV parameters and named GV-SAPS II, specifically for non-diabetic critically ill patients to predict short-term and long-term mortality.


METHODS
Training and validation cohorts were exacted from the Multiparameter Intelligent Monitoring in Intensive Care database III version 1.3 (MIMIC-III v1.3). The GV-SAPS II score was constructed by Cox proportional hazard regression analysis and compared with the original SAPS II, Sepsis-related Organ Failure Assessment Score (SOFA) and Elixhauser scoring systems using area under the curve of the receiver operator characteristic (auROC) curve.


RESULTS
4,895 and 5,048 eligible individuals were included in the training and validation cohorts, respectively. The GV-SAPS II score was established with four independent risk factors, including hyperglycemia, hypoglycemia, standard deviation of blood glucose levels (GluSD), and SAPS II score. In the validation cohort, the auROC values of the new scoring system were 0.824 (95% CI: 0.813-0.834, P< 0.001) and 0.738 (95% CI: 0.725-0.750, P< 0.001), respectively for 30 days and 9 months, which were significantly higher than other models used in our study (all P < 0.001). Moreover, Kaplan-Meier plots demonstrated significantly worse outcomes in higher GV-SAPS II score groups both for 30-day and 9-month mortality endpoints (all P< 0.001).


CONCLUSIONS
We established and validated a modified prognostic scoring system that integrated glucose variability for non-diabetic critically ill patients, named GV-SAPS II. It demonstrated a superior prognostic capability and may be an optimal scoring system for prognostic evaluation in this patient group.
Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Wen-Yue
WY
Liu
School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, 325000, China.
Shi-Gang
SG
Lin
Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, 325000, China.
Gui-Qi
GQ
Zhu
Dept of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
Sven Van
SV
Poucke
Global Medicines Development, AstraZeneca R&D, Loughborough, United Kingdom.
Martin
M
Braddock
Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, 321000, China.
Zhongheng
Z
Zhang
Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China.
Zhi
Z
Mao
Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Fei-Xia
FX
Shen
Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, 325000, China.
Ming-Hua
http://orcid.org/0000-0003-4984-2631
MH
Zheng
D001786:Blood Glucose / Q000032:analysis*; D016638:Critical Illness / Q000145:classification* / Q000401:mortality; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis; D007003:Hypoglycemia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012720:Severity of Illness Index
D001786:Blood Glucose