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BioMed Research International
Volume 2014, Article ID 158051, 7 pages
http://dx.doi.org/10.1155/2014/158051
Research Article

Development of an Open-Heart Intraoperative Risk Scoring Model for Predicting a Prolonged Intensive Care Unit Stay

1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
3Clinical Epidemiology Unit (CEU), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
4Department of Clinical Immunology, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand

Received 6 February 2014; Revised 7 March 2014; Accepted 21 March 2014; Published 10 April 2014

Academic Editor: Cheng I. Cheng

Copyright © 2014 Sirirat Tribuddharat et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Based on a pilot study with 34 patients, applying the modified sequential organ failure assessment (SOFA) score intraoperatively could predict a prolonged ICU stay, albeit with only 4 risk factors. Our objective was to develop a practicable intraoperative model for predicting prolonged ICU stay which included more relevant risk factors. Methods. An extensive literature review identified 6 other intraoperative risk factors affecting prolonged ICU stay. Another 168 patients were then recruited for whom all 10 risk factors were extracted and analyzed by logistic regression to form the new prognostic model. Results. The multivariate logistic regression analysis retained only 6 significant risk factors in the model: age ≥ 60 years, PaO2/FiO2 ratio ≤ 200 mmHg, platelet count ≤ 120,000/mm3, requirement for inotrope/vasopressor ≥ 2 drugs, serum potassium ≤ 3.2 mEq/L, and atrial fibrillation grading ≥2. This model was then simplified into the Open-Heart Intraoperative Risk (OHIR) score, comprising the same 6 risk factors for a total score of 7—a score of ≥3 indicating a likely prolonged ICU stay (AUC for ROC of 0.746). Conclusions. We developed a new, easy to calculate OHIR scoring system for predicting prolonged ICU stay as early as 3 hours after CPB. It comprises 6 risk factors, 5 of which can be manipulated intraoperatively.