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Ressources et utilitaires

Scoring systems for ICU and surgical patients:

Initial PARSONNET
(Predictive score for acquired adult heart surgery : Additive and Logistic Regression models) 

Sex	Age	Morbid obesity
Male Female	< 70 years 70 - 74 years 75 - 79 years >= 80 years	Yes (>=1.5 * ideal weight) No
Diabetes	Ejection Fraction	Hypertension
Yes (unspecified type) No	>= 50% 30 - 49 % < 30 %	Yes (BP > 140/90 mmHg) or antihypertensive medications No
Reoperation	Preoperative IABP	Left ventricular aneurysm
None First Second	Yes No	Yes No
Emergency surgery	Dialysis	Aortic valve surgery
Yes (following PTCA or catheterization complications) No	Yes (hemodialysis or peritoneal) No	Yes Yes (with gradient >= 120 mmHg) No
CABG at time of valve surgery	"Additive Model" Univariate analysis: Predicted probability of operative mortality = SUM ((weight for risk factor) * (1 if factor present, 0 if absent)) =	Mitral valve surgery
Yes No		Yes Yes ( with Systolic PAP >=60 mmHg) No
Catastrophic states		Other rare circumstances
e.g. acute structural defect, cardiogenic shock acute renal failure or other conditions (select the level of severity) Zero One Two Three Four Five		Paraplegia, pacemaker dependency, congenital heart disease in adult severe asthma or other conditions (select the level of severity) Zero One Two Three Four Five

Multivariate Logistic Regression Model

Preoperative Risk Factors (definitions)	Values : 1 if yes, 0 otherwise ( except for age and LVEF)	Beta	p
Age		0.054	< 0.001
Aortic valve disease	Yes		NS *
Bypass only	Yes		0.038
Bypass + other procedure	Yes		0.002
Elevated cholesterol	Yes		NS
Diabetes	Yes		< 0.001
Catastrophic states	Yes		< 0.001
Familly history	Yes		NS
Female gender	Yes		< 0.001
Hypertension	Yes		0.028
Left ventricular aneurysm	Yes		NS *
Left ventricular ejection fraction	EF >= 50% EF 30 - 49% EF< 30%		0.001
Mitral valve disease	Yes		< 0.001
Obesity	Yes		0.027 *
Preoperative IABP	Yes		< 0.001
Reoperation	Yes		< 0.001
Smoking	Yes		NS
Logit = -7.032 + sum (values * beta) Predicted death rate within 30 days = 1 / ( 1 + e -Logit)			* factors were predicitive of increased risk of operative mortality in univariate analysis

Predicted Death Rate     

 

Ref : Parsonnet V et al. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation. 1989;79:I 3-12.

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Definitions of risk factors

One can assume the definitions are the same as in Additive Model.
For several risk factors (smoking, cholesterol...), definitions are not available.

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