• Gianluca Villa, Timothy Amass, Rosa Giua, Iacopo Lanini, Cosimo Chelazzi, Lorenzo Tofani, Rory McFadden, A Raffaele De Gaudio, Sean OMahony, Mitchell M Levy, and Stefano Romagnoli.
• Section of Anesthesiology, Intensive Care and Pain Therapy, Departmnt of Health Sciences, University of Florence, Florence, Italy. gianluca.villa@unifi.it.
• BMC Anesthesiol. 2020 Mar 9; 20 (1): 6363.

BackgroundThe "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.Materials And MethodsAdult 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.ResultsTwo 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.ConclusionsENDING-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.Trial RegistrationClinicaltrials.gov Identifier: NCT02875912; First registration August 4, 2016.

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