0820: A prognostic model for post-operative risk stratification of critically ill patients with faecal peritonitis
Published Date: 03rd January 2018
Publication Authors: Tridente A
INTRODUCTION
Prognostic models of illness severity are useful both clinically and for research purposes. A specific tool for prognostication in critically ill patients with faecal peritonitis is not available.
OBJECTIVES
We aimed to develop two prognostic models, for the prediction of 6 months and 28 day mortality of post-operative critically ill patients with faecal peritonitis
METHODS
Patients admitted to intensive care units with faecal peritonitis and recruited to the UK GAinS or European GenOSept studies up to January 2011 were divided into a derivation and an geographic validation subset; patients subsequently recruited to GAinS 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 the prognostic model, using stepwise selection and nonparametric bootstrapping sampling techniques. Using Area under the Receiver-Operator 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% Confidence Interval, 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 were superior to those obtained with the SOFA and APACHE II scores.
CONCLUSIONS
The two prognostic models developed for 6 month and 28 day mortality prediction in critically ill septic patients with FP, in the post-operative phase, enhanced the SOFA score´s predictive utility by adding few key variables: age, lowest recorded temperature, highest recorded heart rate and haematocrit. Before considering introduction of the scores into clinical practice to inform decision making and the design of clinical trials, it is necessary to conduct external validation in larger cohorts of their predictive capability.
Tridente, A. et al. (2017). 0820: A prognostic model for post-operative risk stratification of critically ill patients with faecal peritonitis. Intensive Care Medicine Experimental . 5 (Suppl 2), p416