Development and validation of a prediction model for postoperative intensive care unit admission in patients with non-cardiac surgery

Xu，Zhikun1; Yao，Shihua2; Jiang，Zhongji3; Hu，Linhui4; Huang，Zijun5; Zeng，Quanjun6; Liu，Xueyan1

2023-11-01

10.1016/j.hrtlng.2023.08.001

Heart and Lung   Impact Factor & Quartile

0147-9563

1527-3288

Background: Accurately forecasting patients admitted to the intensive care units (ICUs) after surgery may improve clinical outcomes and guide the allocation of expensive and limited ICU resources. However, studies on predicting postoperative ICU admission in non-cardiac surgery have been limited. Objective: To develop and validate a prediction model combining pre- and intraoperative variables to predict ICU admission after non-cardiac surgery. Methods: This study is based on data from the Vital Signs DataBase (VitalDB) database. Predictors were selected using the least absolute shrinkage and selection operator regression method and logistic regression to develop a nomogram and an online web calculator. The model was internally verified by 1000-Bootstrap resampling. Performance of model was evaluated using area under the receiver operating characteristic curve (AUC), calibration curve and Brier score. The Youden's index was used to find the optimal nomogram's probability threshold. Clinical utility was assessed by decision curve analysis. Results: This study included 5216 non-cardiac surgery patients; of these, 812 (15.6%) required postoperative ICU admission. Potential predictors included age, ASA classification, surgical department, emergency surgery, preoperative albumin level, preoperative urea nitrogen level, intraoperative crystalloid, intraoperative transfusion, intraoperative catheterization, and surgical time. A nomogram was constructed with an AUC of 0.917 (95% CI: 0.907–0.926) and a Brier score of 0.077. The Bootstrap-adjusted AUC was 0.914; the adjusted Brier score was 0.078. The calibration curve showed good agreement between predicted and actual probabilities; and the decision curve indicated clinical usefulness. Finally, we established an online web calculator for clinical application (https://xuzhikun.shinyapps.io/postopICUadmission1/). Conclusion: We developed and internally validated an easy-to-use nomogram for predicting ICU admission after non-cardiac surgery.

Critical care admission Nomogram Non-cardiac surgery Prediction model Risk assessment

SCI

English

First ; Corresponding

Shenzhen Key Laboratory of Pre-vention and Treatment of Severe Infections[SZXK045] ; null[ZDSYS20200811142804014]

Cardiovascular System & Cardiology ; Nursing ; Respiratory System

Cardiac & Cardiovascular Systems ; Nursing ; Respiratory System

WOS:001059425300001

MOSBY-ELSEVIER

CLINICAL MEDICINE

2-s2.0-85169843416

Scopus

1.Department of Critical Care Medicine,Shenzhen People's Hospital,First Affiliated Hospital of Southern University of Science and Technology,The Second Affiliated Hospital of Jinan University,Shenzhen,518020,China
2.Division of Cardiovascular Surgery,Cardiac and Vascular Center,The University of Hong Kong-Shenzhen Hospital,Shenzhen,518053,China
3.Department of Biology,School of Medicine,Shenzhen Center,Cancer Hospital Chinese Academy of Medical Sciences,Southern University of Science and Technology,Shenzhen,Guangdong,518055,China
4.Department of Critical Care Medicine,Maoming People's Hospital,The Affiliated Maoming Hospital of Southern Medical University,Maoming,525000,China
5.Department of Anesthesiology,Maoming People's Hospital,The Affiliated Maoming Hospital of Southern Medical University,Maoming,525000,China
6.Department of Anesthesiology,University of Chinese Academy of Sciences Shenzhen Hospital,Shenzhen,518107,China

Xu，Zhikun,Yao，Shihua,Jiang，Zhongji,et al. Development and validation of a prediction model for postoperative intensive care unit admission in patients with non-cardiac surgery[J]. Heart and Lung,2023,62:207-214.

Xu，Zhikun.,Yao，Shihua.,Jiang，Zhongji.,Hu，Linhui.,Huang，Zijun.,...&Liu，Xueyan.(2023).Development and validation of a prediction model for postoperative intensive care unit admission in patients with non-cardiac surgery.Heart and Lung,62,207-214.

Xu，Zhikun,et al."Development and validation of a prediction model for postoperative intensive care unit admission in patients with non-cardiac surgery".Heart and Lung 62(2023):207-214.