Risk stratification dates to the dawn of the cardiac intensive care unit (CICU). As the CICU has evolved from a dedicated unit caring for patients with acute myocardial infarction to a complex healthcare environment encompassing a broad array of acute and chronic cardiovascular pathology, an expanding array of risk scores are available that can be applied to CICU patients. Most of these scores were designed for use either in patients with a specific acute cardiovascular diagnosis or unselected critically ill patients, and risk scores developed in other populations often underperform in the CICU. More recently, risk scores have been developed specific to the CICU population, demonstrating improved performance. All existing risk scores have relevant limitations, both in terms of performance and applicability to patient care. Risk scores have been predominantly developed to predict short-term mortality, either by quantifying severity of illness or by incorporating other risk factors for mortality. It is essential to distinguish mortality risk attributable to severity of illness, which may be modifiable through intervention, from mortality risk attributable to non-modifiable risk factors. This review discusses established risk scores applicable to the CICU population, details how risk score performance is characterized, describes how new risk scores can be developed, explains how the information provided by risk scores can be used in clinical practice, and highlights how novel risk stratification approaches can be developed.

中文翻译：

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当代心脏重症监护病房死亡风险评分的过去、现在和未来

风险分层可追溯到心脏重症监护病房 (CICU) 的诞生之日。随着 CICU 已从护理急性心肌梗死患者的专门单位发展为涵盖各种急性和慢性心血管疾病的复杂医疗环境，可用于 CICU 患者的风险评分范围不断扩大。这些评分中的大多数被设计用于具有特定急性心血管诊断的患者或未经选择的危重患者，而在其他人群中开发的风险评分通常在 CICU 中表现不佳。最近，已经针对 CICU 人群开发了风险评分，表明其表现有所改善。所有现有的风险评分在性能和对患者护理的适用性方面都有相关限制。风险评分主要用于预测短期死亡率，无论是通过量化疾病的严重程度还是通过结合其他死亡率风险因素。必须区分归因于疾病严重程度的死亡风险（可通过干预改变）和归因于不可改变的风险因素的死亡风险。这篇综述讨论了适用于 CICU 人群的既定风险评分，详细说明了如何表征风险评分表现，描述了如何开发新的风险评分，解释了如何在临床实践中使用风险评分提供的信息，并强调了新的风险分层如何可以开发方法。通过量化疾病的严重程度或结合其他死亡风险因素。必须区分归因于疾病严重程度的死亡风险（可通过干预改变）和归因于不可改变的风险因素的死亡风险。这篇综述讨论了适用于 CICU 人群的既定风险评分，详细说明了如何表征风险评分表现，描述了如何开发新的风险评分，解释了如何在临床实践中使用风险评分提供的信息，并强调了新的风险分层如何可以开发方法。通过量化疾病的严重程度或结合其他死亡风险因素。必须区分归因于疾病严重程度的死亡风险（可通过干预改变）和归因于不可改变的风险因素的死亡风险。这篇综述讨论了适用于 CICU 人群的既定风险评分，详细说明了如何表征风险评分表现，描述了如何开发新的风险评分，解释了如何在临床实践中使用风险评分提供的信息，并强调了新的风险分层如何可以开发方法。