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A Simplified Mortality Score Using Delta Neutrophil Index and the Thrombotic Microangiopathy Score for Prognostication in Critically Ill Patients

 Eun K Goag  ;  Jong W Lee  ;  Yun H Roh  ;  Ah Y Leem  ;  Song Y Kim  ;  Joo H Song  ;  Eun Y Kim  ;  Ji Y Jung  ;  Moo S Park  ;  Young S Kim  ;  Se K Kim  ;  Joon Chang  ;  Kyung S Chung 
 Shock, Vol.49(1) : 39-43, 2018 
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BACKGROUND: This study was conducted to assess the prognostic value of a simplified mortality score (SMS) using the delta neutrophil index (DNI) and thrombotic microangiopathy (TMA) score, both easily obtained from the complete blood count, to identify critically ill patients at high risk of death. METHODS: This was a retrospective study performed in the medical ICU at Yonsei University College of Medicine from June 2015 to February 2016. The primary end point was 28-day all-cause mortality. Participants were divided into two groups: a training (n = 232) and a test (n = 57) set. We used Cox proportional-hazards analysis, Harrell's C index, and Kaplan-Meier survival analysis to derive the SMS and test its internal validity. RESULTS: We enrolled 289 patients. The 28-day mortality rate was 31.1% (n = 90). Nonsurvivors had higher APACHE II, SOFA, and TMA scores, and DNI. The SMS, derived by Cox proportional-hazards analysis, consisted of age, sex, DNI, and TMA score. We assigned a weighted point to each variable in the SMS, as follows: age + 11 if male + (2 x DNI) + (61 [TMA = 1], 76 [TMA = 2], 74 [TMA = 3], 26 [TMA = 4], 99 [TMA = 5]). Nonsurvivors had a higher median SMS than survivors, and the Harrell's C index was 0.660. Analysis of survival by risk group according to SMS (low, intermediate, high risk) showed a significant difference among these three groups (P < 0.001). We then investigated this SMS in the test set to determine internal validity; the results were similar to those of the training set. CONCLUSIONS: The SMS is a more rapid, simple prognostic score for predicting 28-day mortality and stratifying risk than the APACHE II or SOFA scores. However, external validation using a larger sample is needed.
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Yonsei Authors
곽은경(Goag, Eun Kyong)
김세규(Kim, Se Kyu)
김송이(Kim, Song Yee) ORCID logo https://orcid.org/0000-0001-8627-486X
김영삼(Kim, Young Sam) ORCID logo https://orcid.org/0000-0001-9656-8482
김은영(Kim, Eun Young) ORCID logo https://orcid.org/0000-0002-3281-5744
박무석(Park, Moo Suk) ORCID logo https://orcid.org/0000-0003-0820-7615
송주한(Song, Joo Han)
임아영(Leem, Ah Young) ORCID logo https://orcid.org/0000-0001-5165-3704
장준(Chang, Joon) ORCID logo https://orcid.org/0000-0003-4542-6841
정경수(Jung, Kyung Soo) ORCID logo https://orcid.org/0000-0003-1604-8730
정지예(Jung, Ji Ye) ORCID logo https://orcid.org/0000-0003-1589-4142
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