Mortality prediction

The prediction of early mortality by the ROX index of oxygenation and respiratory rate in diverse Canadian and Ugandan cohorts of unselected patient: a post-hoc retrospective analysis of 80,558 patient observations

Original Articles, Volume 21, Issue 2, Pages 65-120 (2022)

Aim: To investigate the association between in-hospital mortality and the ROX index of respiratory rate and oxygenation in diverse cohorts of unselected patient at different prediction windows.
Methods: A retrospective post-hoc analysis of data from a major regional referral Canadian hospital and a low-resource hospital in sub-Saharan Africa.
Results: Four patient cohorts were examined: Canadian medical, surgical and intensive care unit (ICU) patients, and all patients admitted to an African hospital. In all patients in-hospital mortality rose as ROX declined. Apart from ICU patients, ROX had a high discrimination for death within 72 hours. For non-ICU patients the negative predictive value of death within 72 hours for a ROX value <22 ranged from 0.994 to 1.000 Conclusion: In diverse cohorts of unselected patients, the ROX index has a high discrimination for death within 72 hours. However, the index has little or no prognostic value for patient admitted to ICU.

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The Problems with Risk Prediction during an Emergency Medical Admission Using Laboratory Data – Evidence from Potassium

Original Articles, Volume 18, Issue 1, Pages 1 – 60 (2019)

Background: The prediction of clinical outcomes using biochemical markers is an important tool.

Methods: We calculated a risk score for all emergency admissions 2002-2017. We related potassium and mortality in a multivariable fractional polynomial model. We investigated the potassium distribution and relationship of potassium to mortality over time.

Results: There were 106,586 admissions in 54,928 patients. Mortality was higher for those with an admission potassium above the median – 6.1% vs 4.6% (p<0.001), OR 1.07 (95%CI: 1.06, 1.09). There was a progressive increase in mortality from the lowest – 8.9% (95%CI: 8.3%, 9.4%) to highest potassium decile – 14.2% (95%CI: 13.5%, 14.8%). The frequency of admission hypokalaemia and the mortality at any given potassium decreased over time. Conclusion: Admission potassium predicts mortality.

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