Predicting mortality in moderate-severe TBI patients without early withdrawal of life-sustaining treatments including ICU complications: The MYSTIC-score

Han Yan Michelle Chang; Julie Flahive; Abigail Bose; Kelsey Goostrey; Marcey Osgood; Raphael Carandang; Wiley Hall; Susanne Muehlschlegel

doi:10.1016/j.jcrc.2022.154147

Predicting mortality in moderate-severe TBI patients without early withdrawal of life-sustaining treatments including ICU complications: The MYSTIC-score

J Crit Care. 2022 Dec:72:154147. doi: 10.1016/j.jcrc.2022.154147. Epub 2022 Sep 24.

Authors

Han Yan Michelle Chang¹, Julie Flahive², Abigail Bose³, Kelsey Goostrey⁴, Marcey Osgood⁵, Raphael Carandang⁶, Wiley Hall⁷, Susanne Muehlschlegel⁸

Affiliations

¹ Departments of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA. Electronic address: hanyan.chang@umassmed.edu.
² Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA. Electronic address: julie.flahive@umassmed.edu.
³ Departments of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA. Electronic address: Abigail.bose@umassmemorial.org.
⁴ Departments of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA. Electronic address: kgoostrey@partners.org.
⁵ Departments of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA; Surgery and University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA. Electronic address: marceyl.osgood@umassmemorial.org.
⁶ Departments of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA; Surgery and University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA; Anesthesia/Critical Care, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA. Electronic address: raphael.carandang@umassmemorial.org.
⁷ Departments of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA; Surgery and University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA. Electronic address: wiley.hall@umassmemorial.org.
⁸ Departments of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA; Surgery and University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA; Anesthesia/Critical Care, University of Massachusetts Chan Medical School, 55 Lake Ave North, S-5., Worcester, MA 01655, USA. Electronic address: susanne.muehlschlegel@umassmed.edu.

PMID: 36166912
DOI: 10.1016/j.jcrc.2022.154147

Abstract

Purpose: To develop and internally validate the MortalitY in Moderate-Severe TBI plus ICU Complications (MYSTIC)-Score to predict in-hospital mortality of msTBI patients without early (<24 h) withdrawal-of-life-sustaining treatments.

Methods: We analyzed data from a Neuro-Trauma Intensive Care Unit prospectively collected between 11/2009-5/2019. Consecutive adult msTBI patients were included if Glasgow Coma Scale≤12, and neither died nor had withdrawal-of-life-sustaining treatments within 24 h of admission (n = 485). Using univariate and multivariable logistic regression in a random-split cohort approach (2/3 derivation;1/3 validation), we identified independent predictors of in-hospital mortality while adjusting for validated predictors of mortality (IMPACT-variables). We constructed the MYSTIC-Score and examined discrimination and calibration.

Results: The MYSTIC-Score included the ICU complications brain edema, herniation, systemic inflammatory response syndrome, sepsis, acute kidney injury, cardiac arrest, and urinary tract infection. In the derivation cohort(n = 324), discrimination and calibration were excellent (area-under-the-receiver-operating-curve [AUC-ROC] = 0.95;Hosmer-Lemeshow p-value = 0.09, with p > 0.05 indicating good calibration). Internal validation revealed an AUC-ROC = 0.93 and Hosmer-Lemeshow-p-value = 0.76 (n = 161).

Conclusions: Certain ICU complications are independent predictors of in-hospital mortality and strengthen outcome prediction in msTBI when combined with validated admission predictors of mortality. However, external validation is needed to determine robustness and practical applicability of our model given the high potential for residual confounders.

Keywords: Hospital complications; Neurocritical care; Outcomes research; Prediction score; Traumatic brain injury.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Brain Injuries, Traumatic* / therapy
Cohort Studies
Glasgow Coma Scale
Hospital Mortality
Humans
Intensive Care Units*
Prognosis