This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (443)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Stanley Lemeshow, PhD; Daniel Teres, MD, FCCM; Janelle Klar, MS; Jill Spitz Avrunin, MS; Stephen H. Gehlbach, MD, MPH; John Rapoport, PhD

JAMA. 1993;270(20):2478-2486.

Abstract
Objective.
—To revise and update models in the Mortality Probability Model (MPM II) system to estimate the probability of hospital mortality among 19124 intensive care unit (ICU) patients that can be used for quality assessment within and among ICUs.

Design and Setting.
—Models developed and validated on consecutive admissions to adult medical and surgical ICUs in 12 countries.

Patients.
—A total of 12610 patients for model development, 6514 patients for model validation. Patients younger than 18 years and burn, coronary care, and cardiac surgery patients were excluded.

Outcome Measure.
—Vital status at hospital discharge.

Results.
—The admission model, MPM₀, contains 15 readily obtainable variables. In developmental and validation samples it calibrated well (goodness-of-fit tests: P=.623 and P=.327, respectively, where a high P value represents good fit between observed and expected values) and discriminated well (area under the receiver operating characteristic curve=0.837 and 0.824, respectively). The 24-hour model, MPM₂₄ (developed on 10357 patients still in the ICU at 24 hours), contains five of the admission variables and eight additional variables easily ascertained at 24 hours. It also calibrated well (P=.764 and^P=.231 in the developmental and validation samples, respectively) and discriminated well (area under the receiver operating characteristic curve=0.844 and 0.836 in the developmental and validation samples, respectively).

Conclusions.
—Among severity systems for intensive care patients, the MPM₀ is the only model available for use at ICU admission. Both MPM₀ and MPM₂₄ are useful research tools and provide important clinical information when used alone or together.

(JAMA. 1993;270:2478-2486)

Author Affiliations
From the School of Public Health, University of Massachusetts, Amherst (Drs Lemeshow and Gehlbach and Mss Klar and Avrunin); the Critical Care Division, Baystate Medical Center, Springfield, Mass, and Tufts University School of Medicine, Boston, Mass (Dr Teres); and the Department of Economics, Mount Holyoke College, South Hadley, Mass (Dr Rapoport).

Footnotes
A complete list of study participants in Data Sets I and II appears at the end of this article.

Reprint requests to Critical Care Division, Baystate Medical Center, Springfield, MA 01199 (Dr Teres).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

ICU Admissions After Actual or Planned Hospital Discharge: Incidence, Clinical Characteristics, and Outcomes in Patients With Cancer
Chawla et al.
Chest 2009;136:1257-1262.
ABSTRACT | FULL TEXT  

Application of the Sequential Organ Failure Assessment (SOFA) Score to Patients With Cancer Admitted to the Intensive Care Unit
Namendys-Silva et al.
AM J HOSP PALLIAT CARE 2009;26:341-346.
ABSTRACT  

A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study
Goto et al.
Nephrol Dial Transplant 2009;24:3068-3074.
ABSTRACT | FULL TEXT  

Risk Score for Predicting Outcome in Patients With Asymptomatic Aortic Stenosis
Monin et al.
Circulation 2009;120:69-75.
ABSTRACT | FULL TEXT  

Variation in ICU Risk-Adjusted Mortality: Impact of Methods of Assessment and Potential Confounders
Kuzniewicz et al.
Chest 2008;133:1319-1327.
ABSTRACT | FULL TEXT  

Definitive Care for the Critically Ill During a Disaster: A Framework for Allocation of Scarce Resources in Mass Critical Care: From a Task Force for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL
Devereaux et al.
Chest 2008;133:51S-66S.
ABSTRACT | FULL TEXT  

Establishing an association between a peri-operative perfusion score system (PerfSCORE) and post-operative patient morbidity/mortality during CPB cardiac surgery
Jegger et al.
Perfusion 2007;22:311-316.
ABSTRACT  

Review of the Acuity Scoring Systems for the Pediatric Intensive Care Unit and Their Use in Quality Improvement
Marcin and Pollack
J Intensive Care Med 2007;22:131-140.
ABSTRACT  

Quantifying Risk and Benchmarking Performance in the Adult Intensive Care Unit
Higgins
J Intensive Care Med 2007;22:141-156.
ABSTRACT  

Outcome of Patients With Small-Vessel Vasculitis Admitted to a Medical ICU
Khan et al.
Chest 2007;131:972-976.
ABSTRACT | FULL TEXT  

Enhancement of Claims Data to Improve Risk Adjustment of Hospital Mortality
Pine et al.
JAMA 2007;297:71-76.
ABSTRACT | FULL TEXT  

Mediators or Markers of Injury, Inflammation, and Infection (Harbingers of Doom or Predictors of Disaster) and Biologic Puzzles or Ambiguities
Baue
Arch Surg 2007;142:89-93.
FULL TEXT  

Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score
Adrie et al.
Eur Heart J 2006;27:2840-2845.
ABSTRACT | FULL TEXT  

Risk stratification of severe sepsis patients in the emergency department.
Chen et al.
Emerg. Med. J. 2006;23:281-285.
ABSTRACT | FULL TEXT  

Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity
Rivers et al.
CMAJ 2005;173:1054-1065.
ABSTRACT | FULL TEXT  

Renal Failure Secondary to Acute Tubular Necrosis: Epidemiology, Diagnosis, and Management
Gill et al.
Chest 2005;128:2847-2863.
ABSTRACT | FULL TEXT  

Outcome of Cancer Patients Considered for Intensive Care Unit Admission: A Hospital-Wide Prospective Study
Thiery et al.
JCO 2005;23:4406-4413.
ABSTRACT | FULL TEXT  

Determinants of Mortality in Patients with Severe Sepsis
Johnston
Med Decis Making 2005;25:374-386.
ABSTRACT  

Linezolid versus Vancomycin in Treatment of Complicated Skin and Soft Tissue Infections
Weigelt et al.
Antimicrob. Agents Chemother. 2005;49:2260-2266.
ABSTRACT | FULL TEXT  

Outcome of Morbid Obesity in the Intensive Care Unit
Yaegashi et al.
J Intensive Care Med 2005;20:147-154.
ABSTRACT  

Identifying Potentially Ineffective Care in the Sickest Critically Ill Patients on the Third ICU Day
Afessa et al.
Chest 2004;126:1905-1909.
ABSTRACT | FULL TEXT  

Outcome of Patients With End-Stage Renal Disease Admitted to the Intensive Care Unit
Dara et al.
Mayo Clin Proc. 2004;79:1385-1390.
ABSTRACT  

Monitoring Therapeutic Interventions in Critically Ill Septic Patients
Marik
Nutr Clin Pract 2004;19:423-432.
ABSTRACT | FULL TEXT  

Timing Is Everything
Higgins
Chest 2004;126:4-6.
FULL TEXT  

The characteristics of very short stay ICU admissions and implications for optimizing ICU resource utilization: the Saudi experience
Arabi et al.
Int J Qual Health Care 2004;16:149-155.
ABSTRACT | FULL TEXT  

Predicting Mortality Among Patients Hospitalized for Heart Failure: Derivation and Validation of a Clinical Model
Lee et al.
JAMA 2003;290:2581-2587.
ABSTRACT | FULL TEXT  

Impact of Body Mass Index on Outcomes Following Critical Care
Tremblay and Bandi
Chest 2003;123:1202-1207.
ABSTRACT | FULL TEXT  

Predicting Outcome in Ischemic Stroke: External Validation of Predictive Risk Models
Johnston et al.
Stroke 2003;34:200-202.
ABSTRACT | FULL TEXT  

Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A Systematic Review
Pronovost et al.
JAMA 2002;288:2151-2162.
ABSTRACT | FULL TEXT  

Defining and Improving Data Quality in Medical Registries: A Literature Review, Case Study, and Generic Framework
Arts et al.
J. Am. Med. Inform. Assoc. 2002;9:600-611.
ABSTRACT | FULL TEXT  

Influence of Combined Intravenous and Topical Antibiotic Prophylaxis on the Incidence of Infections, Organ Dysfunctions, and Mortality in Critically Ill Surgical Patients: A Prospective, Stratified, Randomized, Double-Blind, Placebo-controlled Clinical Trial
Krueger et al.
Am. J. Respir. Crit. Care Med. 2002;166:1029-1037.
ABSTRACT | FULL TEXT  

Current Issues Affecting Critical Care Practice
Higgins
SEMIN CARDIOTHORAC VASC ANESTH 2002;6:279-284.
ABSTRACT  

Analytic Reviews: Considerations in the Development of Intensive Care Unit Report Cards
Gupta et al.
J Intensive Care Med 2002;17:211-217.
ABSTRACT  

A case-control analysis of readmissions to the cardiac surgical intensive care unit
Chung et al.
Eur. J. Cardiothorac. Surg. 2002;22:282-286.
ABSTRACT | FULL TEXT  

D-dimer Correlates With Proinflammatory Cytokine Levels and Outcomes in Critically Ill Patients*
Shorr et al.
Chest 2002;121:1262-1268.
ABSTRACT | FULL TEXT  

APACHE 1978-2001: The Development of a Quality Assurance System Based on Prognosis: Milestones and Personal Reflections
Knaus
Arch Surg 2002;137:37-41.
FULL TEXT  

Calibration of the paediatric index of mortality score for UK paediatric intensive care Authors' reply
Tibby et al.
Arch. Dis. Child. 2002;86:65-66.
FULL TEXT  

Morbid Obesity in the Medical ICU
El-Solh et al.
Chest 2001;120:1989-1997.
ABSTRACT | FULL TEXT  

Bayesian Models for Early Warning of Bank Failures
Sarkar and Sriram
Management Science 2001;47:1457-1475.
ABSTRACT  

Systemic Inflammatory Response Syndrome, Organ Failure, and Outcome in Critically Ill Obstetric Patients Treated in an ICU
Afessa et al.
Chest 2001;120:1271-1277.
ABSTRACT | FULL TEXT  

Predicting Mortality in Patients Suffering From Prolonged Critical Illness : An Assessment of Four Severity-of-Illness Measures
Carson and Bach
Chest 2001;120:928-933.
ABSTRACT | FULL TEXT  

Development and Validation of a Prognostic Index for 1-Year Mortality in Older Adults After Hospitalization
Walter et al.
JAMA 2001;285:2987-2994.
ABSTRACT | FULL TEXT  

Results of Report Cards for Patients with Congestive Heart Failure Depend on the Method Used To Adjust for Severity
Poses et al.
ANN INTERN MED 2000;133:10-20.
ABSTRACT | FULL TEXT  

Clinical Course, Prognostic Factors, and Outcome Prediction for HIV Patients in the ICU : The PIP (Pulmonary Complications, ICU Support, and Prognostic Factors in Hospitalized Patients With HIV) Study
Afessa and Green
Chest 2000;118:138-145.
ABSTRACT | FULL TEXT  

Effect of Varying the Case Mix on the Standardized Mortality Ratio and W Statistic: A Simulation Study
Glance et al.
Chest 2000;117:1112-1117.
ABSTRACT | FULL TEXT  

Outcomes Research in Critical Care . Results of the American Thoracic Society Critical Care Assembly Workshop on Outcomes Research
RUBENFELD et al.
Am. J. Respir. Crit. Care Med. 1999;160:358-367.
FULL TEXT  

Determinants of Hospital Mortality After Coronary Artery Bypass Grafting
Michalopoulos et al.
Chest 1999;115:1598-1603.
ABSTRACT | FULL TEXT  

Mortality Prediction in Cardiac Surgery Patients : Comparative Performance of Parsonnet and General Severity Systems
Martinez-Alario et al.
Circulation 1999;99:2378-2382.
ABSTRACT | FULL TEXT  

Outcome for Cancer Patients Requiring Mechanical Ventilation
Groeger et al.
JCO 1999;17:991-991.
ABSTRACT | FULL TEXT  

Comparison of Outcome From Intensive Care Admission After Adjustment for Case Mix by the APACHE III Prognostic System
Pappachan et al.
Chest 1999;115:802-810.
ABSTRACT | FULL TEXT  

Prevalence and Clinical Outcome Associated with Preexisting Malnutrition in Acute Renal Failure: A Prospective Cohort Study
FIACCADORI et al.
J. Am. Soc. Nephrol. 1999;10:581-593.
ABSTRACT | FULL TEXT  

Predicting survival using simple clinical variables: a case study in traumatic brain injury
Signorini et al.
J. Neurol. Neurosurg. Psychiatry 1999;66:20-25.
ABSTRACT | FULL TEXT  

Prediction of Clinical Severity and Outcome of Ventilator-associated Pneumonia . Comparison of Simplified Acute Physiology Score with Systemic Inflammatory Mediators
FROON et al.
Am. J. Respir. Crit. Care Med. 1998;158:1026-1031.
ABSTRACT | FULL TEXT  

Prognostic Indicators for Blood and Marrow Transplant Patients Admitted to an Intensive Care Unit
PRICE et al.
Am. J. Respir. Crit. Care Med. 1998;158:876-884.
ABSTRACT | FULL TEXT  

Fair Allocation of Intensive Care Unit Resources
Am. J. Respir. Crit. Care Med. 1997;156:1282-1301.
FULL TEXT  

Cytokine Profile and Correlation to the APACHE III and MPM II Scores in Patients with Sepsis
PRESTERL et al.
Am. J. Respir. Crit. Care Med. 1997;156:825-832.
ABSTRACT | FULL TEXT  

The Effect of Managed Care on ICU Length of Stay: Implications for Medicare
Angus et al.
JAMA 1996;276:1075-1082.
ABSTRACT  

The Relationship Between Age and the Use of DNR Orders in Critical Care Patients: Evidence for Age Discrimination
Boyd et al.
Arch Intern Med 1996;156:1821-1826.
ABSTRACT  

Intensive Care for Critically Ill Elderly: Mortality, Costs, and Quality of Life: Review of the Literature
Chelluri et al.
Arch Intern Med 1995;155:1013-1022.
ABSTRACT  

A Comparison of Four Severity-Adjusted Models to Predict Mortality After Coronary Artery Bypass Graft Surgery
Orr et al.
Arch Surg 1995;130:301-306.
ABSTRACT  

Customized Probability Models for Early Severe Sepsis in Adult Intensive Care Patients
Gall et al.
JAMA 1995;273:644-650.
ABSTRACT  

Modeling the Severity of Illness of ICU Patients: A Systems Update
Lemeshow and Jean-Roger Le
JAMA 1994;272:1049-1055.
ABSTRACT  

A New Simplified Acute Physiology Score (SAPS II) Based on a European/North American Multicenter Study
Le Gall et al.
JAMA 1993;270:2957-2963.
ABSTRACT