ArticleJournal of anesthesia, analgesia and critical care2026
Validity of ICU prognostic risk stratification tools in the oldest patients: a comparative analysis of clinical scores in a multicenter binational cohort.
Article in Journal of anesthesia, analgesia and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Predictive Value of SMART-COP for Adverse Outcomes in Older ICU Patients with Community-Acquired Pneumonia: A Comparison with CURB-65, SOFA, and APACHE II.Journal of clinical medicine · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWith the growing numbers of nonagenarians and centenarians admitted to intensive care, clinicians face complex decisions regarding care appropriateness and intensity. Prognostic tools such as APACHE III, SOFA, and the Australia and New Zealand Risk of Death (ANZROD) model are widely used, yet their validity in very old patients remains uncertain given the influence of frailty, multimorbidity, and age-related physiological changes. In this study, we evaluated and compared the performance of APACHE III, its Risk of Death score, SOFA, and ANZROD in a large binational cohort of ICU-admitted nonagenarians and centenarians, assessing discrimination, calibration, and predictive utility for short- and long-term mortality using AUROC, standardized mortality ratios, and decision curve analysis.
methodsWe conducted a multicenter retrospective cohort study of 40,910 patients aged 90 years and older who were admitted to ICUs across Australia and New Zealand from 2010 to 2024. Discrimination was assessed using time-dependent area under the receiver operating characteristic curve (AUROC). Calibration was evaluated with standardized mortality ratios (SMRs), and clinical utility was examined using decision curve analysis (DCA) across ICU, hospital, 1-month, 6-month, and 1-year mortality outcomes.
resultsANZROD consistently showed the highest discriminative ability, with AUROCs of 0.870 for ICU mortality and 0.768 for 1-month mortality. APACHEIII ROD and APACHE III followed, while SOFA had the lowest AUROCs across all timepoints. SMR analysis revealed overestimation of short term and underestimation of long term mortality by all models. ANZROD had the best calibration for hospital mortality. DCA showed ANZROD provided greater net benefit than the other scores at clinically relevant thresholds.
conclusionsIn this large binational cohort of over 40,000 nonagenarian and centenarian ICU patients, ANZROD outperformed APACHE III and SOFA in short-term mortality prediction, but all models showed poor calibration and declining discrimination over longer horizons. Current scores remain useful for benchmarking but are limited for individual decision-making, underscoring the need for age-specific prognostic tools that integrate frailty, function, and geriatric priorities.
trial registrationACTRN12625000775415 (23/07/2025).
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.