Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit.

Autores de IIS La Fe

• Esther Villarreal Tello

  Autor

Participantes ajenos a IIS La Fe

• Lozano Gomez, Herminia
• Rodriguez Garcia, Adrian
• Rodriguez Esteban, Maria Angeles
• Lopez Ferraz, Cristina
• Murcia Hernández MDP
• Fernandez Zapata, Alberto
• Ruiz Ruiz, Javier
• Fraile Gutierrez, Virginia
• Socias Crespi, Lorenzo
• Pallas Beneyto, Luis Alberto
• Villanueva Anadon, Beatriz
• Porcar Rodado, Elena
• Araiz Burdio, Juan Jose
• researchers of the ARIAM-SEMICYUC registry

Grupos

• Infecciones Respiratorias

  Investigador Principal

  Raúl Méndez Ocaña

• Medicina Intensiva

  Leader

  Álvaro Castellanos Ortega

Abstract

OBJECTIVE: To design a mortality indicator in acute coronary syndrome (ACS) in the intensive care unit (ICU). DESIGN: A multicenter, observational descriptive study was carried out. PARTICIPANTS: Patients with ACS admitted to the ICUs included in the ARIAM-SEMICYUC registry between January 2013 and April 2019. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic parameters, time of access to the healthcare system, and clinical condition. Revascularization therapy, drugs and mortality were analyzed. Cox regression analysis was performed, followed by the design of a neural network. A receiver operating characteristic curve (ROC) was plotted to calculate the power of the new score. Lastly, the clinical utility or relevance of the ARIAM indicator (ARIAM'(s)) was assessed using a Fagan test. RESULTS: A total of 17,258 patients were included in the study, with a mortality rate of 3.5% (n?=?605) at discharge from the ICU. The variables showing statistical significance (P?<?.001) were entered into the supervised predictive model, an artificial neural network. The new ARIAM'(s) yielded a mean of 0.0257 (95%CI: 0.0245-0.0267) in patients discharged from the ICU versus 0.27085 (95%CI: 0.2533-0.2886) in those who died (P?<?.001). The area under the ROC curve of the model was 0.918 (95%CI: 0.907-0.930). Based on the Fagan test, the ARIAM'(s) showed the mortality risk to be 19% (95%CI: 18%-20%) when positive and 0.9% (95%CI: 0.8%-1.01%) when negative. CONCLUSIONS: A new mortality indicator for ACS in the ICU can be established that is more accurate and reproducible, and periodically updated.

Copyright © 2023. Published by Elsevier España, S.L.U.

Keywords

• Acute coronary syndrome; Estratificación; Intensive care unit; Mortalidad; Mortality; Neural networks; Redes neuronales; Stratification; Síndrome coronario agudo; Unidad de cuidados intensivos