Document Detail


Short-term mortality prediction for acute lung injury patients: External validation of the ARDSNet prediction model.
MedLine Citation:
PMID:  21336135     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: An independent cohort of patients with acute lung injury was used to evaluate the external validity of a simple prediction model for short-term mortality previously developed using data from ARDS Network (ARDSNet) trials. DESIGN, SETTING, AND PATIENTS:: Data for external validation were obtained from a prospective cohort study of patients with acute lung injury from 13 intensive care units at four teaching hospitals in Baltimore, MD. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Of the 508 nontrauma, patients with acute lung injury eligible for this analysis, 234 (46%) died inhospital. Discrimination of the ARDSNet prediction model for inhospital mortality, evaluated by the area under the receiver operator characteristic curves, was 0.67 for our external validation data set vs. 0.70 and 0.68 using Acute Physiology and Chronic Health Evaluation II and the ARDSNet validation data set, respectively. In evaluating calibration of the model, predicted vs. observed inhospital mortality for the external validation data set was similar for both low-risk (ARDSNet model score = 0) and high-risk (score = 3 or 4+) patient strata. However, for intermediate-risk (score = 1 or 2) patients, observed inhospital mortality was substantially higher than predicted mortality (25.3% vs. 16.5% and 40.6% vs. 31.0% for score = 1 and 2, respectively). Sensitivity analyses limiting our external validation data set to only those patients meeting the ARDSNet trial eligibility criteria and to those who received mechanical ventilation in compliance with the ARDSNet ventilation protocol did not substantially change the model's discrimination or improve its calibration. CONCLUSIONS:: Evaluation of the ARDSNet prediction model using an external acute lung injury cohort demonstrated similar discrimination of the model as was observed with the ARDSNet validation data set. However, there were substantial differences in observed vs. predicted mortality among intermediate-risk patients with acute lung injury. The ARDSNet model provided reasonable, but imprecise, estimates of predicted mortality when applied to our external validation cohort of patients with acute lung injury.
Authors:
Abdulla Damluji; Elizabeth Colantuoni; Pedro A Mendez-Tellez; Jonathan E Sevransky; Eddy Fan; Carl Shanholtz; Margaret Wojnar; Peter J Pronovost; Dale M Needham
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-17
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Internal Medicine (AD) and the Division of Pulmonary and Critical Care Medicine (MW), Pennsylvania State University, Hershey, PA; the Department of Anesthesiology and Critical Care Medicine (EC, PAM-T, PJP) and the Division of Pulmonary and Critical Care Medicine (JES, ES, EF, DMN), Johns Hopkins University, Baltimore, MD; the Department of Biostatistics (EC), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Johns Hopkins University, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (CS), University of Maryland, Baltimore, MD.
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