Anggraini Permatasari1, Ceva W Pitoyo2, Dita Aditianingsih3, Cleopas M Rumende 2
1Departemen Ilmu Penyakit Dalam FKUI/RSCM
2Divisi Pulmonologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam FKUI/RSCM 3Departemen Anestesi dan Terapi Intensif FKUI/RSCM
ABSTRACT
Background: Critically ill patients are increasing in number with high mortality rates. Prediction model with a good performance is needed to predict their mortalities. Modified Sequential Organ Failure Assessment (MSOFA) is one of the scoring systems which can predict 28 days mortality. It has shown many good results abroad, however it still need to be validated in Indonesia. In order to improve its performance, total serum magnesium is considered too be use as an added variable.
Objective: To evaluate the performance of MSOFA and the value of added magnesium level as predictor of mortality in critically ill patient.
Methods: This is a prospective cohort study. Medical data which consist of physical examination, Glasgow Coma Scale, peripheral oxygen saturation measurement, creatinine and magnesium serum level were obtained from subjects who were admitted to Intensive Care Unit of Cipto Mangunkusumo Hospital during April to July 2013. Subjects were assessed for outcome after 28 days of admission. Calibration performance was evaluated with calibration plot and Hosmer-Lemeshow test. Discrimination value was measured with area under the curve (AUC). Performance of MSOFA and magnesium value were appraised with ROC curve.
Results: A total of 150 critically ill patients was submitted for this study with 33,3% mortality rate. Calibration plot of MSOFA showed r = 0,7 and Hosmer-Lemeshow test showed p = 0,08. Discrimination value was shown by ROC curve with AUC 0,83 (CI 95% 0,76-0,90). With a cut-off value of 1,85 mEq/L, magnesium has shown optimal sensitivity and specificity, 38% and 48% respectively. However, AUC curve do not change after magnesium variable was added. Conclusion: MSOFA has shown a good calibration and discrimination performance in Indonesian people. Magnesium blood level has no added value to MSOFA for predicting mortality in critically ill patients.
Key words: Validation, Modified Sequential Organ Failure Assessment, total serum magnesium, mortality predictior, critically ill patients.
