Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 9, 2022; 11(6): 364-374
Published online Nov 9, 2022. doi: 10.5492/wjccm.v11.i6.364
Scoring systems in critically ill: Which one to use in cancer patients?
Anisha Beniwal, Deven Juneja, Omender Singh, Amit Goel, Akhilesh Singh, Hemant Kumar Beniwal
Anisha Beniwal, Deven Juneja, Omender Singh, Amit Goel, Akhilesh Singh, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
Hemant Kumar Beniwal, Department of Neurosurgery, Dr SNMC Hospital, Jodhpur 342001, India
Author contributions: Beniwal A and Juneja D designed the study; Beniwal A, Juneja D and Beniwal HK collected the data, analyzed the results, performed the majority of the writing and prepared the tables; Singh O, Goel A and Singh A provided critical input in writing the paper and reviewed the manuscript.
Institutional review board statement: Approved by Institutional Scientific Committee of Max Super Speciality Hospital, No. 1944105991.
Informed consent statement: As this was a retrospective study, the need for consent was waived off by the institute’s ethical committee.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, FCCP, MBBS, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket 1, Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: April 26, 2022
Peer-review started: April 26, 2022
First decision: June 8, 2022
Revised: June 12, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: November 9, 2022
ARTICLE HIGHLIGHTS
Research background

The application of prognosticating scoring systems is considered as an important phase in intensive care units (ICUs) since these severity scoring systems estimate the probability of mortality for patients. These scores help the physicians to facilitate resource utilization or continuous quality improvement and to stratify the patients for clinical research. ICU scoring systems can help both patients as well as their attendants to select from further treatment options. Further, the scores calculated by these scoring systems help in evaluating the impact of newer treatment modalities and organizational changes which in turn contributes towards the development of treatment standards. In addition to the above, the scoring systems’ outcomes also help in benchmarking ICU performance and comparing the scores secured by different ICU patient populations so as to find out the differences in mortality.

Research motivation

There is a dearth of studies that compare different generations of scoring systems especially the ones used upon cancer patients admitted in medical oncology ICUs. Only a few studies have assessed their usefulness in cancer patients with conflicting results.

Research objectives

To compare the efficacy of seven commonly employed scoring systems to predict outcomes of critically ill cancer patients.

Research methods

We conducted a retrospective analysis of 400 consecutive cancer patients admitted in the medical intensive care unit over a 2-year period. The primary outcome was hospital mortality and the secondary outcome measure was comparison of various scoring systems in predicting hospital mortality.

Research results

Overall ICU mortality in our study was 43.5% whereas hospital mortality was 57.8%. All scoring systems tested underestimated the mortality. Mortality predicted by MPM II0 predicted death rate (PDR), was closest to that of the actual mortality followed by that of APACHE II, with a standardized mortality rate (SMR) of 1.305 and 1.547, respectively. APACHE III (χ2 = 4.704, P = 0.788) had the best calibration and SOFA score (χ2 = 15.966, P = 0.025) had the worst calibration, but the difference was not statistically significant. All the scores tested had good efficacy and acceptable discrimination, however SAPS III PDR and MPM II0 PDR (AUROC = 0.762), performed better than others. There was a significant correlation between the various scoring systems (P < 0.001).

Research conclusions

Overall, all the scores in our study cohort under-predicted the mortality. The difference in efficacy was not statistically significant in all scores. The choice of scoring system should depend on the ease of use and local preferences as all the scores tested had similar performance.

Research perspectives

There is a lack of an ideal score for prognostication of critically ill cancer patients. In our retrospective study, analyzing data from 400 patients and comparing seven commonly employed critical illness scores, we observed that all the scores had similar efficacy but under-predicted mortality. Therefore, the choice of scoring system should depend on the ease of use and local preferences.