Prediction of 48-hour intensive care unit mortality in hospitalized cancer patients: Accuracy of the EPIC deterioration index and sequential organ failure assessment score.

552 Background: The EPIC deterioration index (EDI) and the Sequential Organ Failure Assessment (SOFA) scores are commonly used in practice. However, no studies have examined their performance in hospitalized cancer patients just before intensive care unit (ICU) transfer, a critical point to decide if ICU transfer would be appropriate. We examined the prognostic accuracy of the EDI and SOFA for 48 h ICU mortality. Methods: This study evaluated consecutive hospitalized medical oncology patients transferred to the ICU from January 1, 2021 to December 31, 2023. Univariable and multivariable logistic regression models examined if EDI scores immediately prior to ICU transfer (EDI-now) and SOFA scores immediately prior to ICU transfer were predictive of 48 h ICU mortality. We assessed the performance of EDI-now, EDI at 24 h before ICU transfer (EDI-24 h), the difference between EDI-24h and EDI-now (EDI-change) and the SOFA scores using the area under the receiver operating characteristic curve (AUROC). Results: There were 1987 hospitalizations amongst 1907 unique patients (mean age=61, male=58%); 236 (11.9%) who died within 48 h of ICU transfer. In the multivariable analysis, EDI-Now (OR [95% CI]; 3.11 [2.26,4.27], p<0.0001) and SOFA (OR [95% CI]; 1.78 [1.31,2.43], p=0.0002) were significantly associated with 48 h ICU mortality. The AUROC for EDI-now, EDI-24 h, EDI-change and SOFA were 0.657, 0.563, 0.635, and 0.621, respectively. The optimal cut-off threshold for EDI-now was 54.7 with 73.7% sensitivity, 54.4% specificity, 17.9% positive predictive value (PPV) and 91.5% negative predictive value (NPV). The optimal cut-off threshold for SOFA score was 5 with 63.1% sensitivity, 53.6% specificity, 15.5% PPV and 91.5% NPV. Conclusions: EDI-now ≥ 55 and SOFA ≥ 5 were associated with greater 48-hour ICU mortality. High NPVs in our study suggest that clinicians could potentially use low EDI and SOFA scores to identify patients at lower risk of dying within 48 hours and perhaps more appropriate for ICU transfer. However, low PPVs indicate that high EDI and SOFA scores cannot be used to predict higher risk of 48-hour mortality prior to ICU transfer. Better prognostic scores are needed for the medical oncology population. Performance of EDI-now and SOFA with different cutoff points. EDI-Now Sensitivity Specificity PPV NPV Overall Accuracy Youden's J Statistic >50 0.81 0.44 0.16 0.94 0.49 0.25 >60 0.58 0.64 0.18 0.92 0.64 0.22 >70 0.36 0.81 0.20 0.90 0.76 0.17 >80 0.12 0.92 0.17 0.89 0.83 0.04 SOFA Sensitivity Specificity PPV NPV Overall Accuracy Youden's J Statistic >4 0.80 0.36 0.14 0.93 0.42 0.16 >6 0.50 0.66 0.17 0.91 0.64 0.16 >8 0.25 0.85 0.19 0.89 0.78 0.11 >10 0.09 0.96 0.26 0.89 0.86 0.06 Abbreviations: EDI: Epic Deterioration Index; NPV: Negative Predictive Value; PPV: Positive Predictive Value; SOFA: Sequential Organ Failure Assessment.