Validation of END-of-life ScorING-system to identify the dying patient: a prospective analysis.

Abstract

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.

• Authors: Gianluca Villa, Timothy Amass, Rosa Giua, Iacopo Lanini, Cosimo Chelazzi, Lorenzo Tofani, Rory McFadden, A Raffaele De Gaudio, Sean OMahony, Mitchell M Levy, Stefano Romagnoli
• Journal: BMC anesthesiology (BMC Anesthesiol) Vol. 20 Issue 1 Pg. 63 (03 09 2020) ISSN: 1471-2253 [Electronic] England
• PMID: 32164567 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Validation Study)

Topics

• Aged
• Cohort Studies
• Critical Care (methods)
• Death
• Female
• Health Status Indicators
• Humans
• Male
• Middle Aged
• Prospective Studies
• Reproducibility of Results
• Sensitivity and Specificity
• Terminal Care (methods)