Faculty Collaboration Database

The SUPPORT prognostic model. Objective estimates of survival for seriously ill hospitalized adults. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med 1995 Feb 01;122(3):191-203

Date

02/01/1995

Pubmed ID

7810938

DOI

10.7326/0003-4819-122-3-199502010-00007

Scopus ID

2-s2.0-0028885344 (requires institutional sign-in at Scopus site)   531 Citations

Abstract

OBJECTIVE: To develop and validate a prognostic model that estimates survival over a 180-day period for seriously ill hospitalized adults (phase I of SUPPORT [Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments]) and to compare this model's predictions with those of an existing prognostic system and with physicians' independent estimates (SUPPORT phase II).

DESIGN: Prospective cohort study.

SETTING: 5 tertiary care academic centers in the United States.

PARTICIPANTS: 4301 hospitalized adults were selected for phase I according to diagnosis and severity of illness; 4028 patients were evaluated from phase II.

MEASUREMENTS: A survival model was developed using the following predictor variables: diagnosis, age, number of days in the hospital before study entry, presence of cancer, neurologic function, and 11 physiologic measures recorded on day 3 after study entry. Physicians were interviewed on day 3. Patients were followed for survival for 180 days after study entry.

RESULTS: The area under the receiver-operating characteristics (ROC) curve for prediction of surviving 180 days was 0.79 in phase I, 0.78 in the phase II independent validation, and 0.78 when the acute physiology score from the APACHE (Acute Physiology, Age, Chronic Health Evaluation) III prognostic scoring system was substituted for the SUPPORT physiology score. For phase II patients, the SUPPORT model had equal discrimination and slightly improved calibration compared with physician's estimates. Combining the SUPPORT model with physician's estimates improved both predictive accuracy (ROC curve area = 0.82) and the ability to identify patients with high probabilities of survival or death.

CONCLUSIONS: A limited amount of readily available clinical information can provide a foundation for long-term survival estimates that are as accurate as physicians' estimates. The best survival estimates combine an objective prognosis with a physician's clinical estimate.

Author List

Knaus WA, Harrell FE Jr, Lynn J, Goldman L, Phillips RS, Connors AF Jr, Dawson NV, Fulkerson WJ Jr, Califf RM, Desbiens N, Layde P, Oye RK, Bellamy PE, Hakim RB, Wagner DP

MESH terms used to index this publication - Major topics in bold

APACHE
Academic Medical Centers
Aged
Critical Illness
Decision Making
Female
Hospital Mortality
Humans
Male
Middle Aged
Models, Statistical
Prognosis
Prospective Studies
ROC Curve
Severity of Illness Index
Survival Analysis
United States