The “END-of-Life ScorING-System” (ENDING-S) was previously developed to identify patients at high-risk of dying in the ICU and to facilitate a practical integration between palliative and intensive care. The aim of this study is to prospectively validate ENDING-S in a cohort of long-term critical care patients. Adult long-term ICU patients (with a length-of-stay> 4 days) were considered for this prospective multicenter observational study. ENDING-S and SOFA score were calculated daily and evaluated against the patient’s ICU outcome. The predictive properties were evaluated through a receiver operating characteristic (ROC) analysis. Two hundred twenty patients were enrolled for this study. Among these, 21.46% died during the ICU stay. ENDING-S correctly predicted the ICU outcome in 71.4% of patients. Sensitivity, specificity, positive and negative predictive values associated with the previously identified ENDING-S cut-off of 11.5 were 68.1, 72.3, 60 and 89.3%, respectively. ROC-AUC for outcome prediction was 0.79 for ENDING-S and 0.88 for SOFA in this cohort. ENDING-S, while not as accurately as in the pilot study, demonstrated acceptable discrimination properties in identifying long-term ICU patients at very high-risk of dying. ENDING-S may be a useful tool aimed at facilitating a practical integration between palliative, end-of-life and intensive care. Clinicaltrials.gov Identifier: NCT02875912; First registration August 4, 2016.

中文翻译：

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验证临终评分系统以识别垂死患者：前瞻性分析。

“生命终结评分系统”(ENDING-S) 之前开发的目的是识别 ICU 中死亡高风险的患者，并促进姑息治疗和重症监护之间的实际整合。本研究的目的是在长期重症监护患者队列中前瞻性验证 ENDING-S。这项前瞻性多中心观察研究考虑了成年长期 ICU 患者（住院时间 > 4 天）。每天计算 ENDING-S 和 SOFA 评分，并根据患者的 ICU 结果进行评估。通过接受者操作特征（ROC）分析来评估预测特性。本研究招募了 220 名患者。其中，21.46%在ICU住院期间死亡。ENDING-S 正确预测了 71.4% 患者的 ICU 结局。与先前确定的 ENDING-S 截止值 11.5 相关的敏感性、特异性、阳性和阴性预测值分别为 68.1%、72.3%、60% 和 89.3%。在该队列中，ENDING-S 的结果预测 ROC-AUC 为 0.79，SOFA 的 ROC-AUC 为 0.88。ENDING-S 虽然不如试点研究那么准确，但在识别死亡风险极高的长期 ICU 患者方面表现出可接受的歧视特性。ENDING-S 可能是一个有用的工具，旨在促进姑息治疗、临终关怀和重症监护之间的实际整合。ClinicalTrials.gov 标识符：NCT02875912；首次注册时间为2016年8月4日。