Derivation and validation of a prognostic model for post-operative risk stratification of critically ill patients with faecal peritonitis

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Title: Derivation and validation of a prognostic model for post-operative risk stratification of critically ill patients with faecal peritonitis
Authors: Tridente, A
Bion, J
Mills, G
Gordon, AC
Clarke, G
Walden, A
Hutton, P
Holloway, P
Chiche, JD
Stueber, F
Garrard, C
Hinds, CJ
Item Type: Journal Article
Abstract: Background Prognostic scores and models of illness severity are useful both clinically and for research. The aim of this study was to develop two prognostic models for the prediction of long-term (6 months) and 28-day mortality of postoperative critically ill patients with faecal peritonitis (FP). Methods Patients admitted to intensive care units with faecal peritonitis and recruited to the European GenOSept study were divided into a derivation and a geographical validation subset; patients subsequently recruited to the UK GAinS study were used for temporal validation. Using all 50 clinical and laboratory variables available on day 1 of critical care admission, Cox proportional hazards regression was fitted to select variables for inclusion in two prognostic models, using stepwise selection and nonparametric bootstrapping sampling techniques. Using Area under the receiver operating characteristic curve (AuROC) analysis, the performance of the models was compared to SOFA and APACHE II. Results Five variables (age, SOFA score, lowest temperature, highest heart rate, haematocrit) were entered into the prognostic models. The discriminatory performance of the 6-month prognostic model yielded an AuROC 0.81 (95% CI 0.76–0.86), 0.73 (95% CI 0.69–0.78) and 0.76 (95% CI 0.69–0.83) for the derivation, geographic and temporal external validation cohorts, respectively. The 28-day prognostic tool yielded an AuROC 0.82 (95% CI 0.77–0.88), 0.75 (95% CI 0.69–0.80) and 0.79 (95% CI 0.71–0.87) for the same cohorts. These AuROCs appeared consistently superior to those obtained with the SOFA and APACHE II scores alone. Conclusions The two prognostic models developed for 6-month and 28-day mortality prediction in critically ill septic patients with FP, in the postoperative phase, enhanced the day one SOFA score’s predictive utility by adding a few key variables: age, lowest recorded temperature, highest recorded heart rate and haematocrit. External validation of their predictive capability in larger cohorts is needed, before introduction of the proposed scores into clinical practice to inform decision making and the design of clinical trials.
Issue Date: 12-Sep-2017
Date of Acceptance: 18-Aug-2017
URI: http://hdl.handle.net/10044/1/50448
DOI: https://dx.doi.org/10.1186/s13613-017-0314-1
ISSN: 2110-5820
Publisher: Springer
Journal / Book Title: Annals of Intensive Care
Volume: 7
Copyright Statement: © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Keywords: Faecal peritonitis
GAinS
GenOSept
Outcome
Prognostication
Sepsis
GenOSept and GAinS Investigators
Publication Status: Published
Article Number: 96
Appears in Collections:Division of Surgery
Faculty of Medicine



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