Development and Validation of a Prediction Model for 1-Year Mortality in Patients With a Hematologic Malignancy Admitted to the ICU

Jan-Willem H.L. Boldingh, MD; M. Sesmu Arbous, MD, PhD; Bart J. Biemond, MD, PhD; Nicole M.A. Blijlevens, MD, PhD; Jasper van Bommel, MD, PhD; Murielle G.E.C. Hilkens, MD, PhD; Nuray Kusadasi, MD, PhD; Marcella C.A. Muller, MD, PhD; Vera A. de Vries, MD, PhD; Ewout W. Steyerberg, PhD; Walter M. van den Bergh, MD, PhD; on behalf of the Hematologic Malignancy Admitted on the ICU (HEMA-ICU) Study Group

doi:10.1097/CCE.0000000000001093

Critical Care Explorations (Jun 2024)

Development and Validation of a Prediction Model for 1-Year Mortality in Patients With a Hematologic Malignancy Admitted to the ICU

Jan-Willem H.L. Boldingh, MD,
M. Sesmu Arbous, MD, PhD,
Bart J. Biemond, MD, PhD,
Nicole M.A. Blijlevens, MD, PhD,
Jasper van Bommel, MD, PhD,
Murielle G.E.C. Hilkens, MD, PhD,
Nuray Kusadasi, MD, PhD,
Marcella C.A. Muller, MD, PhD,
Vera A. de Vries, MD, PhD,
Ewout W. Steyerberg, PhD,
Walter M. van den Bergh, MD, PhD,
on behalf of the Hematologic Malignancy Admitted on the ICU (HEMA-ICU) Study Group

Affiliations

Jan-Willem H.L. Boldingh, MD: 1 Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
M. Sesmu Arbous, MD, PhD: 3 Department of Critical Care, Leiden University Medical Center, Leiden, The Netherlands.
Bart J. Biemond, MD, PhD: 4 Department of Hematology, Amsterdam University Medical Center (location AMC), University of Amsterdam, Amsterdam, The Netherlands.
Nicole M.A. Blijlevens, MD, PhD: 5 Department of Hematology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
Jasper van Bommel, MD, PhD: 6 Department of Critical Care, Erasmus Medical Center, Rotterdam, The Netherlands.
Murielle G.E.C. Hilkens, MD, PhD: 7 Department of Critical Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
Nuray Kusadasi, MD, PhD: 6 Department of Critical Care, Erasmus Medical Center, Rotterdam, The Netherlands.
Marcella C.A. Muller, MD, PhD: 9 Department of Critical Care, Amsterdam University Medical Center (location AMC), University of Amsterdam, Amsterdam, The Netherlands.
Vera A. de Vries, MD, PhD: 1 Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ewout W. Steyerberg, PhD: 10 Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
Walter M. van den Bergh, MD, PhD: 1 Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
on behalf of the Hematologic Malignancy Admitted on the ICU (HEMA-ICU) Study Group

DOI: https://doi.org/10.1097/CCE.0000000000001093
Journal volume & issue: Vol. 6, no. 6
p. e1093

Abstract

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OBJECTIVES:. To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU. DESIGN:. A retrospective cohort study. SETTING:. Five university hospitals in the Netherlands between 2002 and 2015. PATIENTS:. A total of 1097 consecutive patients with a hematologic malignancy were acutely admitted to the ICU for at least 24 h. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. We created a 13-variable model from 22 potential predictors. Key predictors included active disease, age, previous hematopoietic stem cell transplantation, mechanical ventilation, lowest platelet count, acute kidney injury, maximum heart rate, and type of malignancy. A bootstrap procedure reduced overfitting and improved the model’s generalizability. This involved estimating the optimism in the initial model and shrinking the regression coefficients accordingly in the final model. We assessed performance using internal–external cross-validation by center and compared it with the Acute Physiology and Chronic Health Evaluation II model. Additionally, we evaluated clinical usefulness through decision curve analysis. The overall 1-year mortality rate observed in the study was 62% (95% CI, 59–65). Our 13-variable prediction model demonstrated acceptable calibration and discrimination at internal–external validation across centers (C-statistic 0.70; 95% CI, 0.63–0.77), outperforming the Acute Physiology and Chronic Health Evaluation II model (C-statistic 0.61; 95% CI, 0.57–0.65). Decision curve analysis indicated overall net benefit within a clinically relevant threshold probability range of 60–100% predicted 1-year mortality. CONCLUSIONS:. Our newly developed 13-variable prediction model predicts 1-year mortality in hematologic malignancy patients admitted to the ICU more accurately than the Acute Physiology and Chronic Health Evaluation II model. This model may aid in shared decision-making regarding the continuation of ICU care and end-of-life considerations.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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