Ward mortality after ICU discharge: a multicenter validation of the Sabadell score

• Published in: Intensive care medicine 2010-07, Vol.36 (7), p.1196-1201
• Main Authors: Fernandez, Rafael, Serrano, Jose Manuel, Umaran, Isabel, Abizanda, Ricard, Carrillo, Andres, Lopez-Pueyo, Mª Jesus, Rascado, Pedro, Balerdi, Begoña, Suberviola, Borja, Hernandez, Gonzalo
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; APACHE; Biological and medical sciences; Critical Care Medicine; Critical Illness - classification; Critical Illness - mortality; Do-not-resuscitate orders; Emergency Medicine; Female; Hematology; Hospital Mortality; Hospital patients; Humans; Intensive; Intensive care; Intensive care medicine; Intensive Care Units; Investigative techniques, diagnostic techniques (general aspects); Male; Medical prognosis; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Original; Ostomy; Pain Medicine; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patient Discharge; Patient outcomes; Pediatrics; Pneumology/Respiratory System; Prognosis; Proportional Hazards Models; Prospective Studies; Quality of life; Reproducibility of Results; Spain; Spain - epidemiology; Variables; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-1825-5

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.