A simple classification model for hospital mortality in patients with acute lung injury managed with lung protective ventilation

Lisa M Brown, Carolyn S. Calfee, Michael A. Matthay, Roy G. Brower, B. Taylor Thompson, William Checkley

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: Despite improvements in the care of critically ill patients, hospital mortality rate for acute lung injury remains high at approximately 40%. We developed a classification rule to stratify mechanically ventilated patients with acute lung injury according to hospital mortality and compared this rule with the Acute Physiology and Chronic Health Evaluation III prediction. Patients: We used data of 2,022 participants in Acute Respiratory Distress Syndrome Network trials to build a classification rule based on 54 variables collected before randomization. Design: We used a classification tree approach to stratify patients according to hospital mortality using a training subset of 1800 participants and estimated expected prediction errors using tenfold crossvalidation. We validated our classification tree using a subset of 222 participants not included in model building and calculated areas under the receiver operating characteristic curves. Measurements and Main Results: We identified combinations of age (>63 yrs), blood urea nitrogen (>15 mg/dL), shock, respiratory rate (>21 breaths/min), and minute ventilation (>13.9 L/min) as important predictors of hospital mortality at 90 days. The classification tree had a similar expected prediction error in the training set (28% vs. 26%; p = .18) and areas under the receiver operating characteristic curve in the validation set (0.71 vs. 0.73; p = .71) as did a model based on Acute Physiology and Chronic Health Evaluation III. Conclusions: Our tree-based classification rule performed similarly to Acute Physiology and Chronic Health Evaluation III in stratifying patients according to hospital mortality, is simpler to use, contains risk factors that may be specific to acute lung injury, and identified minute ventilation as a potential novel predictor of death in patients with acute lung injury.

Original languageEnglish (US)
Pages (from-to)2645-2651
Number of pages7
JournalCritical Care Medicine
Volume39
Issue number12
DOIs
StatePublished - Dec 2011
Externally publishedYes

Fingerprint

Acute Lung Injury
Hospital Mortality
Ventilation
Lung
APACHE
ROC Curve
Blood Urea Nitrogen
Adult Respiratory Distress Syndrome
Respiratory Rate
Random Allocation
Critical Illness
Shock
Mortality

Keywords

  • acute lung injury
  • classification
  • outcomes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

A simple classification model for hospital mortality in patients with acute lung injury managed with lung protective ventilation. / Brown, Lisa M; Calfee, Carolyn S.; Matthay, Michael A.; Brower, Roy G.; Thompson, B. Taylor; Checkley, William.

In: Critical Care Medicine, Vol. 39, No. 12, 12.2011, p. 2645-2651.

Research output: Contribution to journalArticle

Brown, Lisa M ; Calfee, Carolyn S. ; Matthay, Michael A. ; Brower, Roy G. ; Thompson, B. Taylor ; Checkley, William. / A simple classification model for hospital mortality in patients with acute lung injury managed with lung protective ventilation. In: Critical Care Medicine. 2011 ; Vol. 39, No. 12. pp. 2645-2651.
@article{f0351f151e394f6b8805cfc3de221ae1,
title = "A simple classification model for hospital mortality in patients with acute lung injury managed with lung protective ventilation",
abstract = "Objective: Despite improvements in the care of critically ill patients, hospital mortality rate for acute lung injury remains high at approximately 40{\%}. We developed a classification rule to stratify mechanically ventilated patients with acute lung injury according to hospital mortality and compared this rule with the Acute Physiology and Chronic Health Evaluation III prediction. Patients: We used data of 2,022 participants in Acute Respiratory Distress Syndrome Network trials to build a classification rule based on 54 variables collected before randomization. Design: We used a classification tree approach to stratify patients according to hospital mortality using a training subset of 1800 participants and estimated expected prediction errors using tenfold crossvalidation. We validated our classification tree using a subset of 222 participants not included in model building and calculated areas under the receiver operating characteristic curves. Measurements and Main Results: We identified combinations of age (>63 yrs), blood urea nitrogen (>15 mg/dL), shock, respiratory rate (>21 breaths/min), and minute ventilation (>13.9 L/min) as important predictors of hospital mortality at 90 days. The classification tree had a similar expected prediction error in the training set (28{\%} vs. 26{\%}; p = .18) and areas under the receiver operating characteristic curve in the validation set (0.71 vs. 0.73; p = .71) as did a model based on Acute Physiology and Chronic Health Evaluation III. Conclusions: Our tree-based classification rule performed similarly to Acute Physiology and Chronic Health Evaluation III in stratifying patients according to hospital mortality, is simpler to use, contains risk factors that may be specific to acute lung injury, and identified minute ventilation as a potential novel predictor of death in patients with acute lung injury.",
keywords = "acute lung injury, classification, outcomes",
author = "Brown, {Lisa M} and Calfee, {Carolyn S.} and Matthay, {Michael A.} and Brower, {Roy G.} and Thompson, {B. Taylor} and William Checkley",
year = "2011",
month = "12",
doi = "10.1097/CCM.0b013e3182266779",
language = "English (US)",
volume = "39",
pages = "2645--2651",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - A simple classification model for hospital mortality in patients with acute lung injury managed with lung protective ventilation

AU - Brown, Lisa M

AU - Calfee, Carolyn S.

AU - Matthay, Michael A.

AU - Brower, Roy G.

AU - Thompson, B. Taylor

AU - Checkley, William

PY - 2011/12

Y1 - 2011/12

N2 - Objective: Despite improvements in the care of critically ill patients, hospital mortality rate for acute lung injury remains high at approximately 40%. We developed a classification rule to stratify mechanically ventilated patients with acute lung injury according to hospital mortality and compared this rule with the Acute Physiology and Chronic Health Evaluation III prediction. Patients: We used data of 2,022 participants in Acute Respiratory Distress Syndrome Network trials to build a classification rule based on 54 variables collected before randomization. Design: We used a classification tree approach to stratify patients according to hospital mortality using a training subset of 1800 participants and estimated expected prediction errors using tenfold crossvalidation. We validated our classification tree using a subset of 222 participants not included in model building and calculated areas under the receiver operating characteristic curves. Measurements and Main Results: We identified combinations of age (>63 yrs), blood urea nitrogen (>15 mg/dL), shock, respiratory rate (>21 breaths/min), and minute ventilation (>13.9 L/min) as important predictors of hospital mortality at 90 days. The classification tree had a similar expected prediction error in the training set (28% vs. 26%; p = .18) and areas under the receiver operating characteristic curve in the validation set (0.71 vs. 0.73; p = .71) as did a model based on Acute Physiology and Chronic Health Evaluation III. Conclusions: Our tree-based classification rule performed similarly to Acute Physiology and Chronic Health Evaluation III in stratifying patients according to hospital mortality, is simpler to use, contains risk factors that may be specific to acute lung injury, and identified minute ventilation as a potential novel predictor of death in patients with acute lung injury.

AB - Objective: Despite improvements in the care of critically ill patients, hospital mortality rate for acute lung injury remains high at approximately 40%. We developed a classification rule to stratify mechanically ventilated patients with acute lung injury according to hospital mortality and compared this rule with the Acute Physiology and Chronic Health Evaluation III prediction. Patients: We used data of 2,022 participants in Acute Respiratory Distress Syndrome Network trials to build a classification rule based on 54 variables collected before randomization. Design: We used a classification tree approach to stratify patients according to hospital mortality using a training subset of 1800 participants and estimated expected prediction errors using tenfold crossvalidation. We validated our classification tree using a subset of 222 participants not included in model building and calculated areas under the receiver operating characteristic curves. Measurements and Main Results: We identified combinations of age (>63 yrs), blood urea nitrogen (>15 mg/dL), shock, respiratory rate (>21 breaths/min), and minute ventilation (>13.9 L/min) as important predictors of hospital mortality at 90 days. The classification tree had a similar expected prediction error in the training set (28% vs. 26%; p = .18) and areas under the receiver operating characteristic curve in the validation set (0.71 vs. 0.73; p = .71) as did a model based on Acute Physiology and Chronic Health Evaluation III. Conclusions: Our tree-based classification rule performed similarly to Acute Physiology and Chronic Health Evaluation III in stratifying patients according to hospital mortality, is simpler to use, contains risk factors that may be specific to acute lung injury, and identified minute ventilation as a potential novel predictor of death in patients with acute lung injury.

KW - acute lung injury

KW - classification

KW - outcomes

UR - http://www.scopus.com/inward/record.url?scp=81855161391&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81855161391&partnerID=8YFLogxK

U2 - 10.1097/CCM.0b013e3182266779

DO - 10.1097/CCM.0b013e3182266779

M3 - Article

VL - 39

SP - 2645

EP - 2651

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 12

ER -