Abstract 16991: Predicting Mortality for Initial Survivors of Acute Respiratory Compromise Events
Introduction: Acute respiratory compromise (ARC) is a common and highly morbid event in hospitalized patients. To date, however, few investigators have explored predictors of outcome in initial survivors of ARC events.
Hypothesis: In this study, we aimed to leverage the Get with the Guidelines Resuscitation (GWTG-R) ARC data registry to develop a prognostic score for initial survivors of ARC events.
Methods: Using the GWTG-R ARC data registry, we identified 13,193 index ARC events occurring in hospitalized patients. These events were divided into a derivation cohort (9,807 patients) and a validation cohort (3,386 patients). A score for predicting in-hospital mortality was developed using multivariable modeling with generalized estimating equations.
Results: The two cohorts were well balanced in terms of baseline demographics, illness-types, pre-event conditions, event characteristics, and overall mortality rates. After model optimization, 9 variables associated with the outcome of interest were included. Age (especially >80 years), hypotension preceding the ARC event, and need for intubation during the event were the greatest predictors of in-hospital mortality. The final score demonstrated good discrimination (c-statistic 0.67) in both the derivation and validation cohorts. The score was also very well calibrated in both cohorts. Observed average mortality was <10% in the lowest score category of both cohorts and >70% in the highest category, illustrating a wide range of mortality separated effectively by the scoring system (see Figure).
Conclusions: We developed and internally validated a well calibrated prognostic score for initial survivors of in-hospital ARC events. This tool will be useful for clinical prognostication, selecting cohorts for interventional studies, and for quality improvement initiatives seeking to risk-adjust survival for hospital-to-hospital comparisons.
Author Disclosures: A. Moskowitz: None. L.W. Andersen: None. M. Karlsson: None. A. Grossestreuer: None. M. Chase: None. M. Cocchi: None. K. Berg: None. M.W. Donnino: None.
- © 2016 by American Heart Association, Inc.