Prediction of Long-Term Physical, Mental, and Cognitive Problems Following Critical Illness: Development and External Validation of the PROSPECT Prediction Model*

Author:

van Sleeuwen Dries12,Zegers Marieke2,Ramjith Jordache3,Cruijsberg Juliette K.4,Simons Koen S.5,van Bommel Daniëlle6,Burgers-Bonthuis Dominique7,Koeter Julia8,Bisschops Laurens L. A.2,Janssen Inge9,Rettig Thijs C. D.10,van der Hoeven Johannes G.2,van de Laar Floris A.1,van den Boogaard Mark2

Affiliation:

1. Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.

2. Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.

3. Department for Health Evidence, Biostatistics Research Group, Radboud University Medical Center, Nijmegen, The Netherlands.

4. IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.

5. Department of Intensive Care Medicine, Jeroen Bosch Hospital, ’s Hertogenbosch, The Netherlands.

6. Department of Intensive Care Medicine, Bernhoven Hospital, Uden, The Netherlands.

7. Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands.

8. Department of Intensive Care Medicine, CWZ, Nijmegen, The Netherlands.

9. Department of Intensive Care Medicine, Maasziekenhuis, Boxmeer, The Netherlands.

10. Department of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Amphia Hospital, Breda, The Netherlands.

Abstract

OBJECTIVES: ICU survivors often suffer from long-lasting physical, mental, and cognitive health problems after hospital discharge. As several interventions that treat or prevent these problems already start during ICU stay, patients at high risk should be identified early. This study aimed to develop a model for early prediction of post-ICU health problems within 48 hours after ICU admission. DESIGN: Prospective cohort study in seven Dutch ICUs. SETTING/PATIENTS: ICU patients older than 16 years and admitted for greater than or equal to 12 hours between July 2016 and March 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Outcomes were physical problems (fatigue or ≥ 3 new physical symptoms), mental problems (anxiety, depression, or post-traumatic stress disorder), and cognitive impairment. Patient record data and questionnaire data were collected at ICU admission, and after 3 and 12 months, of 2,476 patients. Several models predicting physical, mental, or cognitive problems and a composite score at 3 and 12 months were developed using variables collected within 48 hours after ICU admission. Based on performance and clinical feasibility, a model, PROSPECT, predicting post-ICU health problems at 3 months was chosen, including the predictors of chronic obstructive pulmonary disease, admission type, expected length of ICU stay greater than or equal to 2 days, and preadmission anxiety and fatigue. Internal validation using bootstrapping on data of the largest hospital (n = 1,244) yielded a C-statistic of 0.73 (95% CI, 0.70–0.76). External validation was performed on data (n = 864) from the other six hospitals with a C-statistic of 0.77 (95% CI, 0.73–0.80). CONCLUSIONS: The developed and externally validated PROSPECT model can be used within 48 hours after ICU admission for identifying patients with an increased risk of post-ICU problems 3 months after ICU admission. Timely preventive interventions starting during ICU admission and follow-up care can prevent or mitigate post-ICU problems in these high-risk patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine

Cited by 8 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Using augmented intelligence to improve long term outcomes;Current Opinion in Critical Care;2024-10

2. Post-Intensive Care Syndrome;Critical Care Clinics;2024-09

3. Neues Modell zur Langzeitprognose von Intensivpatient*innen;Journal Club AINS;2024-08-28

4. Prognosticating the outcome of intensive care in older patients—a narrative review;Annals of Intensive Care;2024-06-22

5. The authors reply:;Critical Care Medicine;2024-06-13

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