title: Predicting in-hospital mortality for initial survivors of acute respiratory compromise (ARC) events: Development and validation of the ARC Score.
abstract: Acute respiratory compromise (ARC) is a common and highly morbid event in hospitalized patients. To date, however, few investigators have explored predictors of outcome in initial survivors of ARC events. In the present study, we leveraged the American Heart Association's Get With The Guidelines®-Resuscitation (GWTG-R) ARC data registry to develop a prognostic score for initial survivors of ARC events.
  
  
  
  Using GWTG-R ARC data, we identified 13,193 index ARC events. These events were divided into a derivation cohort (9807 patients) and a validation cohort (3386 patients). A score for predicting in-hospital mortality was developed using multivariable modeling with generalized estimating equations.
  
  
  
  The two cohorts were well balanced in terms of baseline demographics, illness-types, pre-event conditions, event characteristics, and overall mortality. After model optimization, nine variables associated with the outcome of interest were included. Age, hypotension preceding the event, and intubation during the event were the greatest predictors of in-hospital mortality. The final score demonstrated good discrimination in both the derivation and validation cohorts. The score was also very well calibrated in both cohorts. Observed average mortality was <10% in the lowest score category of both cohorts and >70% in the highest category, illustrating a wide range of mortality separated effectively by the scoring system.
  
  
  
  In the present study, we developed and internally validated a prognostic score for initial survivors of in-hospital ARC events. This tool will be useful for clinical prognostication, selecting cohorts for interventional studies, and for quality improvement initiatives seeking to risk-adjust for hospital-to-hospital comparisons.
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA, United States. Electronic address: amoskowi@BIDMC.harvard.edu.
authors.forename: Ari
authors.initials: A
authors.lastname: Moskowitz
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars W
authors.initials: LW
authors.lastname: Andersen
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mathias
authors.initials: M
authors.lastname: Karlsson
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States; University of Pennsylvania, Department of Emergency Medicine, Philadelphia, PA, United States.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Grossestreuer
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States.
authors.forename: Maureen
authors.initials: M
authors.lastname: Chase
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States; Beth Israel Deaconess Medical Center, Department of Anesthesia Critical Care and Pain Medicine, Division of Critical Care, United States.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA, United States.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA, United States; Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors
keywords: American Heart Association; Hospital rapid response team; Respiratory failure; Severity of illness index