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Utility Score Can Help Predict Mortality in ICU Patients

Inverted U-shaped relationship for willingness-to-pay by ICU doctor and utility score

FRIDAY, June 5, 2015 (HealthDay News) -- A utility score can help predict poor outcome and survival among patients in the intensive care unit (ICU), according to a study published online May 26 in the Annals of the American Thoracic Society.

Kurien Thomas, M.D., from the Christian Medical College in Vellore, India, and colleagues conducted a 12-month prospective study in a 24-bed medical ICU in India. Health care providers assessed daily the global "utility score" on a 0 to 1 Likert scale, with 0 indicating death/severe disability and 1 indicating cure/perfect health. The authors examined the sensitivity, specificity, and likelihood-ratios of "utility" in predicting ICU mortality. They generated receiver operating characteristic (ROC) curves in order to compare day-two utility with APACHE-II.

The researchers found that for a day-two utility score of ≤0.3, survival without disability was 8.3 percent, compared with 95.8 percent for a day-five score of >0.8 (P < 0.001). As utility values decreased, the likelihood-ratio to predict mortality increased and was highest for utility 0.2. The area under ROC curve was comparable for utility and APACHE-II. Utility did not influence willingness-to-pay by the caregiver, which was 53 percent of treatment cost. There was an inverted U-shaped relationship for willingness-to-pay by ICU doctor and utility.

"Further prospective studies are needed to optimize utilization of scarce ICU resources by identifying patients for appropriate step-down care using utility and willingness-to-pay," the authors write.

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