Validation of the CASUS score in Tunisian patients: a quality management tool in intensive care units

Abstract Background Early prediction of patients at highest risk of a poor outcome after cardiovascular surgery, including death can aid medical decision making, and adapt health care management in order to improve prognosis. In this context, we conducted this study to validate the CASUS severity score after cardiac surgery in the Tunisian population. Methods This is a retrospective cohort study conducted among patients who underwent cardiac surgery under extracorporeal circulation during the year 2018 at the Cardiovascular Surgery Department of La Rabta University Hospital in Tunisia. Data were collected from the patients hospitalization records. The discrimination of the score was assessed using the ROC curve and the calibration using the Hosmer-Lemeshow goodness of fit test and then by constructing the calibration curve. Overall correct classification was also obtained. Results In our study, the observed mortality rate was 10.52% among the 95 included patients. The discriminating power of the CASUS score was estimated by the area under the ROC curve (AUC), this scoring system had a good discrimination with AUC greater than 0.9 from postoperative Day 0 to Day 5.From postoperative day 0 to day 5, the Hosmer-Lemeshow's test gave a value of chi square test statistic ranging from 1.474 to 8.42 and a value of level of significance ranging from 0.39 to 0.99 indicating a good calibration. The overall correct classification rate from postoperative day 0 to day 5 ranged from 84.4% to 92.4%. Conclusions Despite the differences in the profile of the risk factors between the Tunisian population and the population constituting the database used to develop the CASUS score, we can say that this risk model presents acceptable performances in our population, attested by adequate discrimination and calibration. Prospective and especially multicentre studies on larger samples are needed before definitively conclude on the performance of this model in our country. Key messages The casus score seems to be valid to predict mortality among patients undergoing cardiac surgery. Multicenter study on larger sample is needed to derive and validate models able to predict in-hospitals mortality.

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Validation of the EuroSCORE II in a Greek Cardiac Surgical Population: A Prospective Study

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401711010094 ◽

2017 ◽

Vol 11 (1) ◽

pp. 94-101 ◽

Cited By ~ 10

Author(s):

G. Stavridis ◽

D. Panaretos ◽

O. Kadda ◽

D. B. Panagiotakos

Keyword(s):

Cardiac Surgery ◽

Hospital Mortality ◽

Roc Curve ◽

Goodness Of Fit ◽

Operating Characteristic ◽

Goodness Of Fit Test ◽

Actual Mortality ◽

Single Center Study ◽

A Prospective Study

Objective: The objective of this study was to examine the validity of EuroSCORE II in the Greek population. Methods: A prospective single-center study was performed during November 1, 2013 and November 5, 2016; 621 patients undergoing cardiac surgery were enrolled. The EuroSCORE II values and the actual mortality of the patients were recorded in a special database. Calibration of the model was evaluated with the Hosmer-Lemeshow goodness-of-fit test, and discrimination with the areas under the receiver operating characteristic (ROC) curve. Results: The observed in-hospital mortality rate was 3% (i.e. 18/621 patients). The median EuroSCORE II value was 1.3% (1st quartile: 0.86%, 3rd quartile: 2.46%), which indicates a low in-hospital mortality. Area under the ROC curve for EuroSCORE II was 0.85 (95% CI: 0.75-0.94), suggesting very good correct classification of the patients. Conclusion: The findings of the present work suggest that EuroSCORE II is a very good predictor of in-hospital mortality after cardiac surgery, in our population and, therefore can safely be used for quality assurance and risk assessment.

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Pharmacogenetics–Based Preliminary Algorithm to Predict the Incidence of Infection in Patients Receiving Cytotoxic Chemotherapy for Hematological Malignancies: A Discovery Cohort

Frontiers in Pharmacology ◽

10.3389/fphar.2021.602676 ◽

2021 ◽

Vol 12 ◽

Author(s):

Matias F. Martinez ◽

Enzo Alveal ◽

Tomas G. Soto ◽

Eva I. Bustamante ◽

Fernanda Ávila ◽

...

Keyword(s):

Inflammatory Response ◽

Roc Curve ◽

Goodness Of Fit ◽

Health Resources ◽

Cytotoxic Chemotherapy ◽

Goodness Of Fit Test ◽

Lemeshow Test ◽

Life Threatening ◽

Limited Health ◽

Good Diagnostic Accuracy

Introduction: Infections in hematological cancer patients are common and usually life-threatening; avoiding them could decrease morbidity, mortality, and cost. Genes associated with antineoplastics’ pharmacokinetics or with the immune/inflammatory response could explain variability in infection occurrence.Objective: To build a pharmacogenetic-based algorithm to predict the incidence of infections in patients undergoing cytotoxic chemotherapy.Methods: Prospective cohort study in adult patients receiving cytotoxic chemotherapy to treat leukemia, lymphoma, or myeloma in two hospitals in Santiago, Chile. We constructed the predictive model using logistic regression. We assessed thirteen genetic polymorphisms (including nine pharmacokinetic—related genes and four inflammatory response-related genes) and sociodemographic/clinical variables to be incorporated into the model. The model’s calibration and discrimination were used to compare models; they were assessed by the Hosmer-Lemeshow goodness-of-fit test and area under the ROC curve, respectively, in association with Pseudo-R2.Results: We analyzed 203 chemotherapy cycles in 50 patients (47.8 ± 16.1 years; 56% women), including 13 (26%) with acute lymphoblastic and 12 (24%) with myeloblastic leukemia.Pharmacokinetics-related polymorphisms incorporated into the model were CYP3A4 rs2242480C>T and OAT4 rs11231809T>A. Immune/inflammatory response-related polymorphisms were TLR2 rs4696480T>A and IL-6 rs1800796C>G. Clinical/demographic variables incorporated into the model were chemotherapy type and cycle, diagnosis, days in neutropenia, age, and sex. The Pseudo-R2 was 0.56, the p-value of the Hosmer-Lemeshow test was 0.98, showing good goodness-of-fit, and the area under the ROC curve was 0.93, showing good diagnostic accuracy.Conclusions: Genetics can help to predict infections in patients undergoing chemotherapy. This algorithm should be validated and could be used to save lives, decrease economic costs, and optimize limited health resources.

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Comparison of Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in Predicting Mortality in a Pediatric Intensive Care Unit

Journal of Pediatric Intensive Care ◽

10.1055/s-0038-1673671 ◽

2018 ◽

Vol 07 (04) ◽

pp. 201-206 ◽

Cited By ~ 1

Author(s):

Priyamvada Tyagi ◽

Mukesh Agrawal ◽

Milind Tullu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiopulmonary Resuscitation ◽

Roc Curve ◽

Goodness Of Fit ◽

Pediatric Intensive Care ◽

Goodness Of Fit Test ◽

Risk Of Mortality ◽

Pediatric Index Of Mortality ◽

Good Calibration

Aims To compare and validate the Pediatric Risk of Mortality (PRISM) III, Pediatric Index of Mortality (PIM) 2, and PIM 3 scores in a tertiary care pediatric intensive care unit (PICU) (Indian setting). Materials and Methods All consecutively admitted patients in the PICU of a public hospital (excluding those with unstable vital signs or cardiopulmonary resuscitation within 2 hours of admission, cardiopulmonary resuscitation before admission, and discharge or death in less than 24 hours after admission) were included. PRISM III, PIM 2, and PIM 3 scores were calculated. Mortality discrimination for the three scores was calculated using the receiver operating characteristic (ROC) curve, and calibration was performed using the Hosmer–Lemeshow goodness-of-fit test. Results A total of 350 patients were included (male:female = 1.3:1) over the study duration of 18 months (median age: 12 months [interquartile range: 4–60 months]). Nearly half were infants (47.4%). Patients with central nervous system disease were the highest (22.8%) followed by cardiovascular system (20.6%). Mortality rate was 39.4% (138 deaths). The area under the ROC curve for the PRISM III score was 0.667, and goodness-of-fit test showed no significant difference between the observed and expected mortalities in any of these categories (p > 0.5), showing good calibration. Areas under the ROC curve for the PIM 2 and PIM 3 scores were 0.728 and 0.726, respectively. For both the scores, the goodness-of-fit test showed good calibration. Conclusions Although all the three scores demonstrate good calibration, the PIM 2 and PIM 3 scores have an advantage regarding the better discrimination ability, ease of data collection, simplicity of computation, and inherent capacity of not being affected by treatment in PICU.

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A Risk Index for Sternal Surgical Wound Infection After Cardiovascular Surgery

Infection Control and Hospital Epidemiology ◽

10.1086/502110 ◽

2003 ◽

Vol 24 (1) ◽

pp. 17-25 ◽

Cited By ~ 31

Author(s):

Michele Kohli ◽

Lilian Yuan ◽

Michael Escobar ◽

Tyrone David ◽

Grant Gillis ◽

...

Keyword(s):

Cardiac Surgery ◽

Wound Infection ◽

Odds Ratio ◽

Goodness Of Fit ◽

Cardiovascular Surgery ◽

Risk Index ◽

Risk Groups ◽

Surgical Wound Infection ◽

Risk Scores ◽

Surgical Wound

AbstractObjectives:To identify factors that increase the risk of sternal surgical wound infection after cardiovascular surgery and to develop a bedside clinical risk index using these factors.Design:A risk index was developed using clinical data collected from a cohort of 11,508 cardiac surgery patients and validated using three independent subsets of the data. With two of these subsets, we derived a logistic regression equation and then modified the scoring algorithm to simplify the calculation of patient risk scores by clinicians. The final subset was used to validate the index. The area under the receiver operating characteristic (aROC) curve was the primary measure of goodness of fit.Setting:Toronto General Hospital, a teaching hospital and the largest center for cardiac surgery in Ontario, Canada.Patients:Cardiac surgery patients receiving cardiopulmonary bypass between April 1, 1990, and December 31, 1995, who survived at least 6 days after surgery.Results:Variables that were used to construct the risk index included reoperation due to complication (odds ratio, 4.3; range, 1.9 to 8.5), diabetes (odds ratio, 2.4; range, 1.5 to 3.7), more than 3 days in the intensive care unit (odds ratio, 5.4; range, 3.2 to 8.7), and use of the internal mammary artery for revascularization (odds ratio, 3.2; range, 1.7 to 5.8). Validation showed that the index had an aROC curve of 0.64.Conclusions:The risk index described in this article allows clinicians to quickly stratify patients into four risk groups associated with an increasing risk of sternal surgical wound infection. It may be used perioperatively or as part of a wound infection surveillance system.

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Gender Discrimination In Selection On Bureaucratic Jobs: A Case Study Of Sindh Public Service Commission

Pakistan Journal of Gender Studies ◽

10.46568/pjgs.v18i1.36 ◽

2019 ◽

Vol 18 (1) ◽

pp. 249-268

Author(s):

Zahid Ali Channar ◽

Sakina Riaz ◽

Saleem Raza Quresh

Keyword(s):

Public Service ◽

Gender Discrimination ◽

Goodness Of Fit ◽

Annual Reports ◽

Management Tool ◽

Goodness Of Fit Test ◽

Chi Square ◽

Service Commission ◽

The Government ◽

Public Service Commission

This research has focused on gender discrimination in selection on bureaucratic jobs through Sindh Public Service Commission (SPSC). The study was conducted on secondary data collected from annual reports of SPSC.The data was analyzed by the Management tool (fourth-fifths rule)and Statistical technique (Chi-square goodness of fit test). Analysis through 4/5th rule showed that in the combined competitive examination of year 2011, there was huge gender discrimination against females in the appointments of Deputy District Officers’ posts; and for the appointment on the posts of Section Officer, females were again discriminated as compared to males.Gender Discrimination in the appointment on the bureaucratic jobs was also assessed through Chi-Square goodness of fit test. Results yielded by the test showed that there was huge discrimination against females on the appointment of all bureaucratic jobs. This research has implications for the Government, Human Rights Activists and educated females.

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Performance of PRISM III, PELOD-2, and P-MODS Scores in Two Pediatric Intensive Care Units in China

Frontiers in Pediatrics ◽

10.3389/fped.2021.626165 ◽

2021 ◽

Vol 9 ◽

Author(s):

Lidan Zhang ◽

Yuhui Wu ◽

Huimin Huang ◽

Chunyi Liu ◽

Yucai Cheng ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Organ Dysfunction ◽

Roc Curve ◽

Goodness Of Fit ◽

Pediatric Patients ◽

Pediatric Intensive Care ◽

Goodness Of Fit Test ◽

Survival Group

Objective: The performances of the pediatric risk of mortality score III (PRISM III), pediatric logistic organ dysfunction score-2 (PELOD-2), and pediatric multiple organ dysfunction score (P-MODS) in Chinese patients are unclear. This study aimed to assess the performances of these scores in predicting mortality in critically ill pediatric patients.Methods: This retrospective observational study was conducted at two tertiary-care PICUs of teaching hospitals in China. A total of 1,253 critically ill pediatric patients admitted to the two Pediatric Intensive Care Units (PICUs) of the First Affiliated Hospital, Sun Yat-Sen University from August 2014 to December 2019 and Shen-Zhen Children's Hospital from January 2019 to December 2019 were analyzed. The indexes of discrimination and calibration were applied to evaluate score performance for the three models (PRISM III, PELOD-2, and P-MODS scores). The receiver operating characteristic (ROC) curve was plotted, and the efficiency of PRISM III, PELOD-2, and P-MODS in predicting death were evaluated by the area under ROC curve (AUC). Hosmer–Lemeshow goodness-of-fit test was used to evaluate the degree of fitting between the mortality predictions of each scoring system and the actual mortality.Results: A total of 1,253 pediatric patients were eventually enrolled in this study (median age, 38 months; overall mortality rate, 8.9%; median length of PICU stay, 8 days). Compared to the survival group, the non-survival group showed significantly higher PRISM III, PELOD-2, and P-MODS scores [PRISM III: 18 (12, 23) vs. 11 (0, 16); PELOD-2, 8 (4, 10) vs. 4 (0, 6); and P-MODS: 5 (4, 9) vs. 3 (0, 4), all P < 0.001]. ROC curve analysis showed that the AUCs of PRISM III, PELOD-2, and P-MODS for predicting the death of critically ill children were 0.858, 0.721, and 0.596, respectively. Furthermore, in the Hosmer–Lemeshow goodness-of-fit test, PRISM III and PELOD-2 showed the better calibration between predicted mortality and observed mortality (PRISM III: χ2 = 5.667, P = 0.368; PELOD-2: χ2 = 9.582, P = 0.276; P-MODS: χ2 = 12.449, P = 0.015).Conclusions: PRISM III and PELOD-2 can discriminate well between survivors and non-survivors. PRISM III and PELOD-2 showed the better calibration between predicted and observed mortality, while P-MODS showed poor calibration.

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