• Nishant Sahni, Roshan Tourani, Donald Sullivan, and Gyorgy Simon.
• Division of General Internal Medicine, University of Minnesota, Delaware Street SE, MMC 741, Minneapolis, MN, USA. nishant.sahni@gmail.com.
• J Gen Intern Med. 2020 May 1; 35 (5): 1413-1418.

BackgroundPredicting death in a cohort of clinically diverse, multi-condition hospitalized patients is difficult. This frequently hinders timely serious illness care conversations. Prognostic models that can determine 6-month death risk at the time of hospital admission can improve access to serious illness care conversations.ObjectiveThe objective is to determine if the demographic, vital sign, and laboratory data from the first 48 h of a hospitalization can be used to accurately quantify 6-month mortality risk.DesignThis is a retrospective study using electronic medical record data linked with the state death registry.ParticipantsParticipants were 158,323 hospitalized patients within a 6-hospital network over a 6-year period.Main MeasuresMain measures are the following: the first set of vital signs, complete blood count, basic and complete metabolic panel, serum lactate, pro-BNP, troponin-I, INR, aPTT, demographic information, and associated ICD codes. The outcome of interest was death within 6 months.Key ResultsModel performance was measured on the validation dataset. A random forest model-mini serious illness algorithm-used 8 variables from the initial 48 h of hospitalization and predicted death within 6 months with an AUC of 0.92 (0.91-0.93). Red cell distribution width was the most important prognostic variable. min-SIA (mini serious illness algorithm) was very well calibrated and estimated the probability of death to within 10% of the actual value. The discriminative ability of the min-SIA was significantly better than historical estimates of clinician performance.Conclusionmin-SIA algorithm can identify patients at high risk of 6-month mortality at the time of hospital admission. It can be used to improved access to timely, serious illness care conversations in high-risk patients.

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