MORTALITY PROBABILITY-MODELS (MPM-II) BASED ON AN INTERNATIONAL COHORT OF INTENSIVE-CARE UNIT PATIENTS
MORTALITY PROBABILITY-MODELS (MPM-II) BASED ON AN INTERNATIONAL COHORT OF INTENSIVE-CARE UNIT PATIENTS
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DOI：
10.1001/jama.270.20.2478
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发表时间：
1993-11-24
影响因子：
120.7
通讯作者：
RAPOPORT, J
中科院分区：
文献类型：
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作者：
LEMESHOW, S;TERES, D;RAPOPORT, J
目的.-修订和更新死亡率概率模型 (MPM II) 系统中的模型，以估计 19 124 名重症监护病房 (ICU) 患者的医院死亡率概率，可用于 ICU 内部和之间的质量评估。设计和设置。-模型在 12 个国家的成人医疗和外科 ICU 连续入院时开发和验证。患者。-总共 12 610 名患者用于模型开发，6514 名患者用于模型验证。 18 岁以下的患者以及烧伤、冠心病护理和心脏手术患者被排除在外。结果测量。-出院时的生命状况。结果。-入院模型 MPM0 包含 15 个易于获得的变量。在开发和验证样本中，它校准良好（拟合优度检验：分别为 P=.623 和 P=.327，其中高 P 值表示观察值和预期值之间的良好拟合）并且区分良好（受试者工作特征曲线下面积分别为 0.837 和 0.824）。 24 小时模型 MPM24（针对 24 小时仍在 ICU 的 10 357 名患者开发）包含 5 个入院变量和 8 个在 24 小时轻松确定的附加变量。它还具有良好的校准能力（开发样本和验证样本中分别为 P=.764 和 P=.231），区分能力也很好（开发样本和验证样本中的受试者工作特征曲线下面积分别为 0.844 和 0.836）。结论。-在重症监护患者的严重程度系统中，MPM0 是唯一可在 ICU 入院时使用的模型。 MPM0 和 MPM2 都是有用的研究工具，单独或一起使用时可提供重要的临床信息。
Objective.-To revise and update models in the Mortality Probability Model (MPM II) system to estimate the probability of hospital mortality among 19 124 intensive care unit (ICU) patients that can be used for quality assessment within and among ICUs.Design and Setting.-Models developed and validated on consecutive admissions to adult medical and surgical ICUs in 12 countries.Patients.-A total of 12 610 patients for model development, 6514 patients for model validation. Patients younger than 18 years and burn, coronary care, and cardiac surgery patients were excluded.Outcome Measure.-Vital status at hospital discharge.Results.-The admission model, MPM0, contains 15 readily obtainable variables. In developmental and validation samples it calibrated well (goodness-of-fit tests: P=.623 and P=.327, respectively, where a high P value represents good fit between observed and expected values) and discriminated well (area under the receiver operating characteristic curve=0.837 and 0.824, respectively). The 24-hour model, MPM24 (developed on 10 357 patients still in the ICU at 24 hours), contains five of the admission variables and eight additional variables easily ascertained at 24 hours. It also calibrated well (P=.764 and P=.231 in the developmental and validation samples, respectively) and discriminated well (area under the receiver operating characteristic curve=0.844 and 0.836 in the developmental and validation samples, respectively).Conclusions.-Among severity systems for intensive care patients, the MPM0 is the only model available for use at ICU admission. Both MPM0 and MPM2, are useful research tools and provide important clinical information when used alone or together.