Related Experiment Videos
Ward mortality after ICU discharge: a multicenter validation of the Sabadell score
Rafael Fernandez1, Jose Manuel Serrano, Isabel Umaran
1CIBER Enfermedades Respiratorias, ICU, Hospital Sant Joan de Deu, Fundació Althaia, Manresa, Spain. rfernandezf@althaia.cat
Insights
The Sabadell score effectively predicts patient survival after intensive care unit (ICU) discharge. This validated score identifies four patient groups with distinct hospital mortality risks, aiding clinical decision-making.
Area of Science:
- Critical Care Medicine
- Prognostic Modeling
- Health Services Research
Background:
- Predictive tools for post-intensive care unit (ICU) patient outcomes are limited.
- A prior single-center study demonstrated the Sabadell score's ability to stratify patients into four distinct ward mortality groups.
Purpose of the Study:
- To prospectively validate the Sabadell score across multiple centers.
- To assess the score's utility in predicting hospital survival for ICU patients.
Main Methods:
- A prospective, multicenter study involving 31 ICUs in Spain.
- Data collected included patient demographics, severity of illness, ICU treatments, ICU-acquired infections, acute renal failure, and the Sabadell score at ICU discharge.
- Statistical analyses employed ANOVA and multiple regression to evaluate ward mortality prediction.
Main Results:
- 4,132 patients were analyzed, with an overall ward mortality of 6.7%.
- The Sabadell score demonstrated significant predictive power: ward mortality ranged from 1.5% (score 0) to 64% (score 3).
- Multivariate analysis confirmed the Sabadell score's independent association with ward mortality (ORs ranging from 4.7 to 107.2 for scores 1-3).
Conclusions:
- The Sabadell score is a validated tool for stratifying ICU patients into prognostically distinct groups at ICU discharge.
- The score accurately predicts varying likelihoods of hospital survival, supporting its clinical application.
Background:
Tools for predicting post-ICU patients' outcomes are scarce. A single-center study showed that the Sabadell score classified patients into four groups with clear-cut differences in ward mortality.
Objective And Design:
To validate the Sabadell score using a prospective multicenter approach.
Setting:
Thirty-one ICUs in Spain.
Patients And Methods:
All patients admitted in the 3-month study period. We recorded variables at ICU admission (age, sex, severity of illness, and do-not-resuscitate orders), during the ICU stay (ICU-specific treatments, ICU-acquired infection, and acute renal failure), and at ICU discharge (Sabadell score). Statistical analyses included one-way ANOVA and multiple regression analysis with ward mortality as the dependent variable.
Results:
We admitted 4,132 patients (mean age 61.5 +/- 16.7 years) with mean predicted mortality of 23.8 +/- 22.7%; 545 patients (13%) died in the ICU and 3,587 (87%) were discharged to the ward. Overall ward mortality was 6.7%; ward mortality was 1.5% (36/2,422) in patients with score 0 (good prognosis), 9% (64/725) in patients with score 1 (long-term poor prognosis), 23% (79/341) in patients with score 2 (short-term poor prognosis), and 64% (63/99) in patients with score 3 (expected hospital death). Variables associated with ward mortality in the multivariate analysis were predicted risk of death (OR 1.016), ICU readmission (OR 5.9), Sabadell score 1 (OR 4.7), Sabadell score 2 (OR 15.7), and Sabadell score 3 (OR 107.2).
Conclusion:
We confirm the ability of the Sabadell score at ICU discharge to define four groups of patients with very different likelihoods of hospital survival.
