MPM₀-III Calculator

Physiology at ICU admission

Coma or deep stupor GCS 3 (no response) or 4–5 with decorticate/decerebrate posturing. Excludes drug overdose. Use pre-sedation best estimate if on paralytic or anaesthesia. β = +2.050514 * Heart rate ≥ 150 bpm Documented within 1 hour before or after ICU admission β = +0.433188 Systolic BP ≤ 90 mmHg Documented within 1 hour before or after ICU admission β = +1.451005 *

Chronic diagnoses

Chronic Kidney Disease (CKD) Most recent creatinine > 176 µmol/L (2.0 mg/dL) chronically, on dialysis, or prior renal transplant β = +0.5395209 Cirrhosis History of portal hypertension and varices, or biopsy confirmation β = +2.070695 * Metastatic neoplasm Stage IV cancer (excluding regional lymphatic spread only); obvious metastases on imaging or pathology. Includes acute haematologic malignancies (acute leukaemia, aggressive lymphoma). Excludes chronic leukaemia — unless attributable findings are present (sepsis, anaemia, tumour lysis syndrome, lymphangiectatic ARDS) or the patient is under active treatment for the chronic leukaemia. β = +3.204902 *

Acute diagnoses at ICU admission

Acute renal failure / AKI Acute tubular necrosis or acute decompensation of CKD. AKI is present if ANY ONE KDIGO 2012 criterion is met (in absence of known CKD): SCr rise ≥ 0.3 mg/dL (≥ 26.5 µmol/L) within 48 h SCr rise ≥ 1.5× baseline within 7 days Urine output < 0.5 mL/kg/h for ≥ 6 consecutive hours β = +0.8412274 Cardiac dysrhythmia requiring treatment Acute change in heart rhythm: paroxysmal tachycardia, AF with rapid ventricular response, 2nd/3rd-degree heart block, ventricular dysrhythmias. Excludes chronic stable arrhythmias. β = +0.8219612 * Cerebrovascular incident Acute cerebral embolism, occlusion, CVA, stroke, brain stem infarction, or AVM with acute stroke/haemorrhage β = +0.4107686 Gastrointestinal bleeding New-onset melaena or haematemesis with clinically plausible decrease in haemoglobin. Excludes unexplained Hb drop alone or perforated ulcer without bleeding evidence. β = −0.165253 protective Intracranial mass effect Abscess, tumour, or intracranial/subdural haemorrhage on CT/imaging with: midline shift, obliteration of cerebral ventricles, gross intraventricular/SAH haemorrhage, visible mass > 4 cm, or contrast-enhancing mass. β = +1.855276 *

Other factors

CPR within 24 hours before ICU admission Chest compression, defibrillation, or cardiac massage. Excludes emergent intubation alone, or planned electrical stimulation (e.g. electrophysiologic studies, cardiac surgery). β = +1.497258 * Mechanical ventilation within 1 hour of admission Excludes BiPAP/NIV unless delivered via tracheostomy β = +0.821648 Medical or unscheduled surgical admission All patients EXCEPT those admitted following an elective surgical procedure (i.e., scheduled ≥ 24 hours in advance). Elective pre-op ICU admission for a scheduled operation is also excluded (= not ticked). β = +0.9097936 Full code resuscitation status new in MPM₀-III No restrictions on emergency therapies or interventions at time of ICU admission. Excludes patients with DNR or DNI orders. β = −0.7969783 protective

Predicted hospital mortality probability

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Logit (log-odds)

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Constant

−5.36283

Age term

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Interaction sum (7)

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Model source Higgins TL, Teres D, Copes WS, Nathanson BH, Stark M, Kramer AA. Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM₀-III). Crit Care Med. 2007;35(3):827–835. doi:10.1097/01.CCM.0000257337.63529.9F PMID: 17255863

Prospective validation Higgins TL, Kramer AA, Nathanson BH, Copes W, Stark M, Teres D. Crit Care Med. 2009;37(5):1619–1623. PMID: 19295463

AKI criterion KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):1–138. doi:10.1038/kisup.2012.1

* Asterisk = variable carries an age-interaction term (7 total: coma, SBP, cirrhosis, metastatic, cardiac dysrhythmia, intracranial mass, CPR). All coefficients from Table 3, Higgins 2007; verified against Appendix C worked example (logit −2.162, P = 10.3%). AKI operational definition updated to KDIGO 2012; original derivation used ATN/acute CRF decompensation criteria.

For clinical audit, educational and research use only. Not a substitute for clinical judgement. Validated in adult ICU patients (Project IMPACT 2001–2004; n = 124,855; observed mortality 13.8%; AUROC 0.823; SMR 1.018). Excludes cardiac surgery, AMI, burns, age < 18.

MPM₀-III — Mortality Probability Admission Model