Validation of END-of-life ScorING-system to identify the dying patient: a prospective analysis.
End of life
Scoring system
intensive care unit
palliative care
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
09 03 2020
09 03 2020
Historique:
received:
24
11
2019
accepted:
04
03
2020
entrez:
14
3
2020
pubmed:
14
3
2020
medline:
6
7
2021
Statut:
epublish
Résumé
The "END-of-Life ScorING-System" (ENDING-S) was previously developed to identify patients at high-risk of dying in the ICU and to facilitate a practical integration between palliative and intensive care. The aim of this study is to prospectively validate ENDING-S in a cohort of long-term critical care patients. Adult long-term ICU patients (with a length-of-stay> 4 days) were considered for this prospective multicenter observational study. ENDING-S and SOFA score were calculated daily and evaluated against the patient's ICU outcome. The predictive properties were evaluated through a receiver operating characteristic (ROC) analysis. Two hundred twenty patients were enrolled for this study. Among these, 21.46% died during the ICU stay. ENDING-S correctly predicted the ICU outcome in 71.4% of patients. Sensitivity, specificity, positive and negative predictive values associated with the previously identified ENDING-S cut-off of 11.5 were 68.1, 72.3, 60 and 89.3%, respectively. ROC-AUC for outcome prediction was 0.79 for ENDING-S and 0.88 for SOFA in this cohort. ENDING-S, while not as accurately as in the pilot study, demonstrated acceptable discrimination properties in identifying long-term ICU patients at very high-risk of dying. ENDING-S may be a useful tool aimed at facilitating a practical integration between palliative, end-of-life and intensive care. Clinicaltrials.gov Identifier: NCT02875912; First registration August 4, 2016.
Sections du résumé
BACKGROUND
The "END-of-Life ScorING-System" (ENDING-S) was previously developed to identify patients at high-risk of dying in the ICU and to facilitate a practical integration between palliative and intensive care. The aim of this study is to prospectively validate ENDING-S in a cohort of long-term critical care patients.
MATERIALS AND METHODS
Adult long-term ICU patients (with a length-of-stay> 4 days) were considered for this prospective multicenter observational study. ENDING-S and SOFA score were calculated daily and evaluated against the patient's ICU outcome. The predictive properties were evaluated through a receiver operating characteristic (ROC) analysis.
RESULTS
Two hundred twenty patients were enrolled for this study. Among these, 21.46% died during the ICU stay. ENDING-S correctly predicted the ICU outcome in 71.4% of patients. Sensitivity, specificity, positive and negative predictive values associated with the previously identified ENDING-S cut-off of 11.5 were 68.1, 72.3, 60 and 89.3%, respectively. ROC-AUC for outcome prediction was 0.79 for ENDING-S and 0.88 for SOFA in this cohort.
CONCLUSIONS
ENDING-S, while not as accurately as in the pilot study, demonstrated acceptable discrimination properties in identifying long-term ICU patients at very high-risk of dying. ENDING-S may be a useful tool aimed at facilitating a practical integration between palliative, end-of-life and intensive care.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT02875912; First registration August 4, 2016.
Identifiants
pubmed: 32164567
doi: 10.1186/s12871-020-00979-y
pii: 10.1186/s12871-020-00979-y
pmc: PMC7068991
doi:
Banques de données
ClinicalTrials.gov
['NCT02875912']
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
63Subventions
Organisme : Ente Cassa di Risparmio di Firenze
ID : 2014.0679
Pays : International
Organisme : Cox fundation
ID : NA
Pays : International
Organisme : Philip and Irene Toll Gage Foundation
ID : NA
Pays : International
Références
Rev Esc Enferm USP. 2018 Jun 25;52:e03342
pubmed: 29947710
Intensive Care Med. 2010 Sep;36(9):1495-504
pubmed: 20464541
Oncologist. 2017 Mar;22(3):318-323
pubmed: 28220023
Minerva Anestesiol. 2011 Sep;77(9):911-20
pubmed: 21878873
Am J Cardiol. 2015 Mar 1;115(5):687-90
pubmed: 25727085
Am J Respir Crit Care Med. 2011 Feb 1;183(3):348-55
pubmed: 20833820
BMJ Open Qual. 2019 Sep 06;8(3):e000513
pubmed: 31544163
Minerva Anestesiol. 2015 Dec;81(12):1318-28
pubmed: 25616205
Crit Care Med. 2013 Jun;41(6):1405-11
pubmed: 23518869
Minerva Anestesiol. 2017 May;83(5):436-439
pubmed: 28211650
Crit Care Med. 2020 Feb;48(2):176-184
pubmed: 31939785
Crit Care Med. 2003 Feb;31(2):456-61
pubmed: 12576951
Crit Care Med. 2012 Apr;40(4):1105-12
pubmed: 22202706
Am J Respir Crit Care Med. 2010 Jul 1;182(1):6-11
pubmed: 20194809
Crit Care Med. 2004 Mar;32(3):638-43
pubmed: 15090940
J Pain Symptom Manage. 2006 Apr;31(4):285-92
pubmed: 16632076
JAMA. 2003 Aug 13;290(6):790-7
pubmed: 12915432
Crit Care Med. 2009 Mar;37(3):946-50
pubmed: 19237901
Health Expect. 2015 Dec;18(6):2266-77
pubmed: 24816136
JBI Evid Synth. 2020 May;18(5):1144-1153
pubmed: 32813369