TABLE 43

Final coefficients for the ICNARCH-2014 risk prediction model for acute hospital mortality

PredictorCoefficient (SE)
Constant19.093 (6.635)
Physiological predictors
Highest heart rate (beats per minute) – RCS (71, 93, 110, 146) [106]
 hr1–0.00005 (0.00325)
 hr20.05999 (0.01205)
 hr3–0.1927 (0.0350)
Lowest SBP (mmHg) – RCS (66, 89, 102, 130) [95]
 sbp1–0.03310 (0.00735)
 sbp20.10080 (0.02765)
 sbp3–0.3907 (0.1272)
Highest temperature (°C) – RCS (36.0, 37.2, 38.0, 39.2) [37.6]
 temp1–0.1530 (0.0548)
 temp2–0.1349 (0.3290)
 temp31.939 (1.495)
Lowest respiratory rate (breaths per minute) – RRCS (8, 12, 13, 15) [13]
 rr1–0.07682 (0.00690)
 rr20.00772 (0.01019)
 rr3–0.01448 (0.01426)
 rr40.00698 (0.00797)
 rr50.00024 (0.00014)
PaO2/ FiO2 (kPa) – RCS (9.7, 26.0, 39.7, 61.4) [33.0]
 pf1–0.04360 (0.00438)
 pf20.07204 (0.01510)
 pf3–0.17258 (0.04498)
Lowest arterial pH – RCS (7.08, 7.30, 7.36, 7.44) [7.31]
 ph1–0.6547 (0.8709)
 ph2–4.2092 (1.3490)
 ph329.727 (22.008)
PaCO2 (kPa) – RCS (3.9, 5.2, 7.0) [5.4]
 pc12.89904 (0.64885)
 pc20.47630 (0.13307)
Highest blood lactate concentration (mmol/l) – RCS (0.7, 1.5, 2.5, 8.2) [2.8]
 bl1–11.0662 (3.2726)
 bl2188.9267 (51.7254)
 bl3–351.1491 (95.6690)
Urine output (ml) – RCS (164, 1215, 2020, 4255) [1800]
 up1–0.00136 (0.00009)
 up20.002416 (0.00035)
 up3–0.00466 (0.00097)
Highest urea level (mmol/l) – RCS (2.8, 5.6, 9.3, 28.1) [10.5]
 ur1–0.07858 (0.02591)
 ur21.8777 (0.36564)
 ur3–3.4724 (0.6610)
Highest creatinine level (µmol/l) – RRCS (53, 80, 106, 168) [141]
 cr10.00213 (0.00012)
 cr20.29314 (0.12838)
 cr3–0.11159 (0.05119)
 cr40.02867 (0.00790)
 cr5–0.00035 (0.00006)
Highest sodium level (mmol/l) – RCS (133, 139, 145) [139]
 na1–0.05476 (0.00357)
 na20.05908 (0.00386)
Lowest WBC count (× 109/l) – RCS (3.7, 8.7, 12.3, 22.5) [12.0]
 wbc1–0.03935 (0.00759)
 wbc20.21809 (0.03518)
 wbc3–0.60698 (0.10216)
Lowest platelet count (× 109/l) – RCS (60, 162, 232, 422) [211]
 plc1–0.00646 (0.00041)
 plc20.02136 (0.00171)
 plc3–0.05719 (0.00520)
Sedated/paralysed/GCS score [15]
 150
 140.277 (0.0320)
 7–130.533 (0.0294)
 Sedated0.745 (0.0295)
 60.849 (0.0914)
 5 or paralysed and sedated0.928 (0.0582)
 41.273 (0.1142)
 31.751 (0.0596)
Non-physiological predictors
Age (years)0.03723 (0.00073)
Severe liver disease in past medical history11.224 (6.501)
Metastatic disease0.621 (0.0524)
Haematological malignancy0.673 (0.0583)
Dependency prior to admission
 No assistance with daily activities0
 Some assistance with daily activities0.474 (0.0205)
 Total assistance with daily activities0.890 (0.0870)
CPR prior to admission
 Community CPR0
 In-hospital CPR10.892 (3.500)
 No CPR3.732 (2.449)
Source of admission/urgency of surgery
 ED or not in hospital (unplanned admission)0
 ED or not in hospital (planned admission)0.022 (0.1169)
 Other acute hospital (not critical care)0.369 (0.0838)
 Other critical care unit (repatriation)0.593 (0.1131)
 Other critical care unit (planned or unplanned transfer)0.257 (0.0430)
 Theatre (planned admission following elective or scheduled surgery)–0.934 (0.0518)
 Theatre (unplanned admission following elective or scheduled surgery)–0.455 (0.0694)
 Theatre (admission following emergency or urgent surgery)–0.223 (0.0359)
 Ward or intermediate care area0.405 (0.0264)
Primary reason for admission
 Accidental intoxication or poisoning (endocrinea)–0.080 (0.2578)
 Acidaemia (endocrine)–0.117 (0.2274)
 Burns or hyperthermia (dermatological)1.004 (0.3180)
 Collapse (respiratory)2.157 (0.6381)
 Coma or encephalopathy (neurological)0.463 (0.2030)
 Congenital or acquired deformity or abnormality (cardiovascular)0
 Congenital or acquired deformity or abnormality (musculoskeletal)–0.196 (0.2330)
 Congenital or acquired deformity or abnormality (neurological)–2.853 (1.3406)
 Congenital or acquired deformity or abnormality (respiratory)0.940 (0.2046)
 Congenital or acquired deformity or abnormality (endocrine; gastrointestinal; genitourinary; or haematological/immunological)0.040 (0.2081)
 Degeneration (cardiovascular)–0.194 (0.2209)
 Degeneration (neurological)1.837 (0.3511)
 Diabetes mellitus (endocrine)–0.494 (2.8285)
 Dissection or aneurysm (cardiovascular)0.246 (0.1817)
 Failure (cardiovascular)0.574 (0.1848)
 Failure (genitourinary)0.257 (0.1774)
 Haemorrhage (cardiovascular)–0.366 (0.3263)
 Haemorrhage (gastrointestinal)8.352 (2.8243)
 Haemorrhage (genitourinary)–0.574 (0.2988)
 Haemorrhage (neurological)0.370 (0.6378)
 Haemorrhage (respiratory)0.214 (0.2583)
 Hyperkalaemia (endocrine)0.011 (0.2464)
 Hypertension (cardiovascular) or over- or under-activity (cardiovascular; genitourinary)0.198 (0.1800)
 Hypokalaemia (endocrine)–0.494 (0.4010)
 Hyponatraemia (endocrine)–0.268 (0.2864)
 Hypoplasia or dysplasia (haematological/immunological)0.651 (0.3303)
 Hypothermia (endocrine)0.190 (0.2953)
 Infection (cardiovascular)0.775 (0.2100)
 Infection (genitourinary)–0.140 (0.1885)
 Infection (respiratory)2.116 (0.5798)
 Infection (dermatological; gastrointestinal; haematological/immunological; musculoskeletal; or neurological)0.372 (0.1758)
 Inflammation (gastrointestinal)0.486 (0.1799)
 Inflammation (neurological)–0.191 (0.2739)
 Inflammation (respiratory)0.377 (0.1785)
 Inflammation (cardiovascular; dermatological; genitourinary; musculoskeletal)–0.017 (0.2435)
 Obstruction (cardiovascular)0.220 (0.1776)
 Obstruction (gastrointestinal)0.437 (0.1783)
 Obstruction (genitourinary)–0.420 (0.2600)
 Obstruction (respiratory)0.158 (0.1792)
 Other endocrine processesa (endocrine)–0.1557 (0.2333)
 Seizures (neurological)–0.138 (0.1872)
 Self intoxication or self poisoning (endocrine)0.513 (1.0021)
 Shock and hypotension (cardiovascular)0.410 (0.1770)
 Transplant or related (gastrointestinal)–1.125 (0.2922)
 Transplant or related (cardiovascular; endocrine; genitourinary; haematological/immunological; respiratory)0.153 (0.3162)
 Trauma, perforation or rupture (cardiovascular)0.128 (0.2558)
 Trauma, perforation or rupture (gastrointestinal)0.398 (0.1771)
 Trauma, perforation or rupture (neurological)–0.475 (3.8994)
 Trauma, perforation or rupture (dermatological; genitourinary; musculoskeletal; respiratory)0.260 (0.1827)
 Tumour or malignancy (genitourinary)0.052 (0.2007)
 Tumour or malignancy (haematological/immunological)0.116 (0.2997)
 Tumour or malignancy (neurological)0.590 (0.6974)
 Tumour or malignancy (cardiovascular; dermatological; endocrine; gastrointestinal; musculoskeletal; respiratory)11.442 (2.581)
 Vascular (cardiovascular)0.593 (0.1989)
 Vascular (gastrointestinal)0.654 (0.1897)
 Vascular (neurological)1.294 (0.2195)
 Acute alcoholic hepatitis/alcoholic cirrhosis0.670 (0.8356)
 Anaphylaxis–0.950 (0.3475)
 Anoxic or ischaemic coma or encephalopathy0.687 (1.3371)
 Asthma attack in new or known asthmatic–1.132 (0.2533)
 Enteroenteric or enterocutaneous fistula1.667 (0.3242)
 Fractured ribs0.249 (0.2571)
 Fungal or yeast pneumonia1.255 (0.2413)
 Haemolysis or thrombocytopenia–0.027 (0.3676)
 Hanging or strangulation1.790 (0.2644)
 Intracerebral haemorrhage32.963 (14.5399)
 Leaking large bowel anastomosis/perforated biliary tree or gall bladder0.670 (0.8356)
 Lower limb artery stenosis or occlusion1.009 (0.2054)
 Pulmonary fibrosis or fibrosing alveoli2.919 (0.2727)
 Secondary hydrocephalus–2.218 (6.1830)
 Thrombo-occlusive disease of brain1.899 (0.2010)
 Toxic or drug-induced coma or encephalopathy0.129 (0.2480)
Mechanical ventilation0.7160 (0.4495)
Interactions
Arterial pH × PaCO2
 ph1 × pc1–0.42784 (0.09097)
 ph1 × pc2–0.03535 (0.01712)
 ph2 × pc10.58168 (0.21846)
 ph3 × pc1–1.14392 (3.91387)
Arterial pH × blood lactate concentration
 ph1 × bl11.563 (0.4481)
 ph1 × bl2–26.37 (7.0874)
 ph1 × bl349.00 (13.111)
 ph2 × bl1–0.1573 (0.12837)
 ph3 × bl17.797 (2.4084)
Urine output × urea
 up1 × ur10.00005 (0.00001)
 up1 × ur2–0.00065 (0.00015)
 up1 × ur30.00116 (0.00027)
 up2 × ur1–0.00002 (0.00002)
 up3 × ur10.00005 (0.00005)
Liver disease × temperature
 temp1–0.2845 (0.17794)
 temp20.9400 (0.49252)
 temp3–4.648 (1.8547)
CPR × SBP
 In-hospital CPR × sbp10.00043 (0.00940)
 In-hospital CPR × sbp20.01370 (0.03616)
 In-hospital CPR × sbp3–0.03798 (0.16478)
 No CPR × sbp10.01281 (0.00753)
 No CPR × sbp2–0.07066 (0.02817)
 No CPR × sbp30.31309 (0.12912)
CPR × temperature
 In-hospital CPR × temp1–0.3232 (0.09522)
 In-hospital CPR × temp20.8444 (0.45897)
 In-hospital CPR × temp3–3.230 (2.0050)
 No CPR × temp1–0.1547 (0.06646)
 No CPR × temp20.2818 (0.34462)
 No CPR × temp3–1.556 (1.5416)
Collapse (respiratory) × platelet count
 plc1–0.01305 (0.00547)
 plc20.02428 (0.02238)
 plc3–0.04071 (0.06688)
Congenital (neurological) × urine output
 up10.00324 (0.00150)
 up2–0.01064 (0.00576)
 up30.02702 (0.01488)
Diabetes mellitus (endocrine) × heart rate
 hr10.00544 (0.03384)
 hr2–0.1944 (0.11643)
 hr30.7147 (0.32881)
Haemorrhage (gastrological) × sodium level
 na1–0.05819 (0.02074)
 na20.02272 (0.02189)
Haemorrhage (neurological) × urine output
 up1–0.00010 (0.00050)
 up20.00080 (0.00188)
 up3–0.00157 (0.00484)
Haemorrhage (neurological) × blood lactate concentration
 bl10.8467 (0.34277)
 bl2–6.623 (5.9342)
 bl311.09 (11.197)
Infection (respiratory) × heart rate
 hr1–0.01412 (0.00655)
 hr20.03690 (0.02251)
 hr3–0.1021 (0.06348)
Infection (respiratory) × PaO2/FiO2
 pf1–0.01559 (0.00611)
 pf2–0.01082 (0.02796)
 pf30.13753 (0.09825)
Self poisoning (endocrine) × creatinine level
 cr1–0.00098 (0.00174)
 cr2–0.94067 (2.33612)
 cr30.44148 (0.70236)
 cr4–0.13545 (0.09162)
 cr50.00024 (0.00073)
Self poisoning (endocrine) × blood lactate concentration
 bl1–1.347 (0.6578)
 bl229.70 (10.375)
 bl3–56.39 (19.128)
Trauma (neurological) × sodium level
 na1–0.00217 (0.02855)
 na20.04362 (0.02519)
Trauma (neurological) × WBC count
 wbc10.07408 (0.07799)
 wbc2–0.04864 (0.31443)
 wbc30.23081 (0.88934)
Trauma (neurological) × urine output
 up10.0004 (0.00047)
 up2–0.00050 (0.00180)
 up30.00118 (0.00462)
Trauma (neurological) × platelet count
 plc10.00290 (0.00327)
 plc2–0.02458 (0.01346)
 plc30.06889 (0.04086)
Tumour (haematological/immunological) × WBC count
 wbc10.06610 (0.06833)
 wbc20.5778 (0.51906)
 wbc3–2.313 (1.6231)
Tumour (neurological) × urine output
 up10.00007 (0.00075)
 up20.00033 (0.00282)
 up3–0.00053 (0.00722)
Tumour (other) × sodium level
 na1–0.08002 (0.01897)
 na20.06770 (0.02276)
Acute alcoholic hepatitis/alcoholic cirrhosis × urea level
 ur10.02320 (0.17484)
 ur22.009 (2.6257)
 ur3–4.264 (4.7798)
Anoxic/ischaemic coma × SBP
 sbp10.00209 (0.01739)
 sbp20.08982 (0.05797)
 sbp3–0.3009 (0.24374)
Intracerebral haemorrhage × temperature
 temp1–0.8292 (0.39703)
 temp20.6162 (0.94252)
 temp30.1163 (3.23562)
Intracerebral haemorrhage × urine output
 up1–0.00026 (0.00055)
 up20.00181 (0.00212)
 up3–0.00401 (0.00551)
Secondary hydrocephalus × creatinine level
 cr1–0.02572 (0.03126)
 cr2–0.53674 (2.02834)
 cr3–0.30353 (1.05165)
 cr40.06243 (0.23562)
 cr50.00220 (0.00542)
Mechanical ventilation × heart rate
 hr10.00386 (0.00416)
 hr2–0.04434 (0.01538)
 hr30.1481 (0.04462)
Mechanical ventilation × respiratory rate
 rr10.03380 (0.01191)
 rr2–0.01425 (0.01245)
 rr30.03415 (0.01803)
 rr4–0.01939 (0.01019)
 rr5–0.00004 (0.00020)
Mechanical ventilation × PaO2/FiO2
 pf10.02427 (0.00523)
 pf2–0.05202 (0.001912)
 pf30.14406 (0.05891)
Mechanical ventilation × PaCO2
 pc1–0.1153 (0.03488)
 pc20.02085 (0.03791)

ED, emergency department; RCS, restricted cubic splines (knot positions in parentheses); RRCS, right-restricted cubic splines (knot positions in parentheses).

Square brackets indicate mean/normal value for imputation.

a

Alcohol-related disorders, alkalaemia, chromosomal deletion syndromes, contiguous gene syndromes, envenomation, fluid overload, haemorrhage, hypercalcaemia, hyperglycaemia, hypernatraemia, hyperthermia, hypocalcaemia, hypoglycaemia, inborn errors of metabolism, obesity, over-activity, sex chromosome disorders, starvation, trisomy and under-activity.

From: Appendix 2, The new Intensive Care National Audit & Research Centre model: ICNARCH-2014

Cover of Ensuring comparisons of health-care providers are fair: development and validation of risk prediction models for critically ill patients
Ensuring comparisons of health-care providers are fair: development and validation of risk prediction models for critically ill patients.
Health Services and Delivery Research, No. 3.41.
Harrison DA, Ferrando-Vivas P, Shahin J, et al.
Southampton (UK): NIHR Journals Library; 2015 Oct.
Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Harrison et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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