A new prediction model for assessing the clinical outcomes of ICU patients with community-acquired pneumonia: a decision tree analysis. (2nd January 2019)

• Record Type: Journal Article
• Authors: Zhang, Shufang; Zhang, Kai; Yu, Yang; Tian, Baoping; Cui, Wei; Zhang, Gensheng
• Is Part Of: Annals of medicine. Volume 51:Number 1(2019)
• Page Start: 41
• Page End: 50
• Publication Date: 2019-01-02
• Subjects: Intensive care -- mortality -- community-acquired pneumonia; Medicine -- Periodicals; 610
• DOI: 10.1080/07853890.2018.1518580
• Languages: English
• ISSNs: 0785-3890

Abstract

Abstract: Purpose: We aimed to develop a new scoring index based on decision-tree analysis to predict clinical outcomes of patients with community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU). Methods: Data of 3519 ICU patients with CAP were obtained from the Medical Information Mart for Intensive Care III (MIMIC III) 2001–2012 database and analysed between 30-d survivors and non-survivors. Accuracy, sensitivity, and specificity of the new decision tree model were compared with those of CURB-65 and SOAR. Results: The newly developed classification and regression tree (CART) model identified coexisting illnesses as the most important single discriminating factor between survivors and non-survivors. The CART model area under the curve (AUC) 0.661 was superior to that of CURB-65 (0.609) and SOAR (0.589). CART sensitivity was 73.4%, and specificity 49.0%. CURB-65 and SOAR sensitivity for predicting 30-d mortality were 74.5 and 80.7%, and specificity was 42.3 and 33.9%, respectively. After smoothing, the CART model had higher sensitivity and specificity than both CURB-65 and SOAR. Conclusions: The new CART prediction model has higher specificity and better receiver operating characteristics (ROC) curves than CURB-65 and SOAR score indices although its accuracy and sensitivity are only moderately better than the other systems. Key messages: The new CART prediction model has higher specificity and better ROC curves than CURB-65 and SOAR score indices. However, accuracy and sensitivity of the new CART prediction model are only moderately better than the other systems in predicting 30-day mortality in CAP patients.