Korean J Intern Med.
2024 Jul;39(4):625-639. 10.3904/kjim.2022.311.
Development and validation of novel simple prognostic model for predicting mortality in Korean intensive care units using national insurance claims data
- Affiliations
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- 1Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 2Department of Statistics, Graduate School of Chung-Ang University, Seoul, Korea
- 3Institute of Health & Environment, Seoul National University, Seoul, Korea
- KMID: 2556912
- DOI: http://doi.org/10.3904/kjim.2022.311
Abstract
- Background/Aims
Intensive care unit (ICU) quality is largely determined by the mortality rate. Therefore, we aimed to develop and validate a novel prognostic model for predicting mortality in Korean ICUs, using national insurance claims data.
Methods
Data were obtained from the health insurance claims database maintained by the Health Insurance Review and Assessment Service of South Korea. From patients who underwent the third ICU adequacy evaluation, 42,489 cases were enrolled and randomly divided into the derivation and validation cohorts. Using the models derived from the derivation cohort, we analyzed whether they accurately predicted death in the validation cohort. The models were verified using data from one general and two tertiary hospitals.
Results
Two severity correction models were created from the derivation cohort data, by applying variables selected through statistical analysis, through clinical consensus, and from performing multiple logistic regression analysis. Model 1 included six categorical variables (age, sex, Charlson comorbidity index, ventilator use, hemodialysis or continuous renal replacement therapy, and vasopressor use). Model 2 additionally included presence/absence of ICU specialists and nursing grades. In external validation, the performance of models 1 and 2 for predicting in-hospital and ICU mortality was not inferior to that of pre-existing scoring systems.
Conclusions
The novel and simple models could predict in-hospital and ICU mortality and were not inferior compared to the pre-existing scoring systems.
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