Section of Anesthesiology, Intensive Care and Pain Therapy, Departmnt of Health Sciences, University of Florence, Florence, Italy.
Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla,3, 50134, Florence, Italy.
BMC Anesthesiol. 2020 Mar 9;20(1):63. doi: 10.1186/s12871-020-00979-y.
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.
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.
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.
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.
Clinicaltrials.gov Identifier: NCT02875912; First registration August 4, 2016.
“生命终末期评分系统”（ENDING-S）之前被开发出来，用于识别 ICU 中高死亡风险的患者，并促进姑息治疗和重症监护之间的实际整合。本研究的目的是前瞻性验证 ENDING-S 在长期重症监护患者中的应用。
本前瞻性多中心观察性研究纳入了长期 ICU 患者（住院时间>4 天）。每天计算 ENDING-S 和 SOFA 评分，并与患者的 ICU 结局进行评估。通过接收者操作特征（ROC）分析评估预测性能。
本研究共纳入 220 例患者，其中 21.46%的患者在 ICU 期间死亡。ENDING-S 正确预测了 71.4%患者的 ICU 结局。与之前确定的 ENDING-S 截断值 11.5 相关的敏感性、特异性、阳性和阴性预测值分别为 68.1%、72.3%、60%和 89.3%。在该队列中，用于结局预测的 ROC-AUC 为 ENDING-S 的 0.79 和 SOFA 的 0.88。
尽管不如试点研究准确，但 ENDING-S 在识别极有可能死亡的长期 ICU 患者方面表现出可接受的区分性能。ENDING-S 可能是一种有用的工具，旨在促进姑息治疗、生命终末期和重症监护之间的实际整合。
Clinicaltrials.gov 标识符：NCT02875912；首次注册日期：2016 年 8 月 4 日。
