The performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort study
Abstract Background Multiple factors contribute to mortality after ICU, but it is unclear how the predictive value of these factors changes during ICU admission. We aimed to compare the changing performance over time of the acute illness component, antecedent patient characteristics, and ICU length...
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doaj-f7ce4b539ee948f9ae13a56d2585c5b82020-11-25T02:17:22ZengBMCCritical Care1364-85352020-06-012411910.1186/s13054-020-03017-yThe performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort studyMonika C. Kerckhoffs0Sylvia Brinkman1Nicolet de Keizer2Ivo W. Soliman3Dylan W. de Lange4Johannes J. M. van Delden5Diederik van Dijk6Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht UniversityNational Intensive Care Evaluation (NICE) foundationNational Intensive Care Evaluation (NICE) foundationDepartment of Intensive Care Medicine, University Medical Center Utrecht, Utrecht UniversityDepartment of Intensive Care Medicine, University Medical Center Utrecht, Utrecht UniversityDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityDepartment of Intensive Care Medicine, University Medical Center Utrecht, Utrecht UniversityAbstract Background Multiple factors contribute to mortality after ICU, but it is unclear how the predictive value of these factors changes during ICU admission. We aimed to compare the changing performance over time of the acute illness component, antecedent patient characteristics, and ICU length of stay (LOS) in predicting 1-year mortality. Methods In this retrospective observational cohort study, the discriminative value of four generalized mixed-effects models was compared for 1-year and hospital mortality. Among patients with increasing ICU LOS, the models included (a) acute illness factors and antecedent patient characteristics combined, (b) acute component only, (c) antecedent patient characteristics only, and (d) ICU LOS. For each analysis, discrimination was measured by area under the receiver operating characteristics curve (AUC), calculated using the bootstrap method. Statistical significance between the models was assessed using the DeLong method (p value < 0.05). Results In 400,248 ICU patients observed, hospital mortality was 11.8% and 1-year mortality 21.8%. At ICU admission, the combined model predicted 1-year mortality with an AUC of 0.84 (95% CI 0.84–0.84). When analyzed separately, the acute component progressively lost predictive power. From an ICU admission of at least 3 days, antecedent characteristics significantly exceeded the predictive value of the acute component for 1-year mortality, AUC 0.68 (95% CI 0.68–0.69) versus 0.67 (95% CI 0.67–0.68) (p value < 0.001). For hospital mortality, antecedent characteristics outperformed the acute component from a LOS of at least 7 days, comprising 7.8% of patients and accounting for 52.4% of all bed days. ICU LOS predicted 1-year mortality with an AUC of 0.52 (95% CI 0.51–0.53) and hospital mortality with an AUC of 0.54 (95% CI 0.53–0.55) for patients with a LOS of at least 7 days. Conclusions Comparing the predictive value of factors influencing 1-year mortality for patients with increasing ICU LOS, antecedent patient characteristics are more predictive than the acute component for patients with an ICU LOS of at least 3 days. For hospital mortality, antecedent patient characteristics outperform the acute component for patients with an ICU LOS of at least 7 days. After the first week of ICU admission, LOS itself is not predictive of hospital nor 1-year mortality.http://link.springer.com/article/10.1186/s13054-020-03017-yIntensive careMortalityPrognosisAdvance care planningLong-term outcomesCritical illness |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Monika C. Kerckhoffs Sylvia Brinkman Nicolet de Keizer Ivo W. Soliman Dylan W. de Lange Johannes J. M. van Delden Diederik van Dijk |
spellingShingle |
Monika C. Kerckhoffs Sylvia Brinkman Nicolet de Keizer Ivo W. Soliman Dylan W. de Lange Johannes J. M. van Delden Diederik van Dijk The performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort study Critical Care Intensive care Mortality Prognosis Advance care planning Long-term outcomes Critical illness |
author_facet |
Monika C. Kerckhoffs Sylvia Brinkman Nicolet de Keizer Ivo W. Soliman Dylan W. de Lange Johannes J. M. van Delden Diederik van Dijk |
author_sort |
Monika C. Kerckhoffs |
title |
The performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort study |
title_short |
The performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort study |
title_full |
The performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort study |
title_fullStr |
The performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort study |
title_full_unstemmed |
The performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort study |
title_sort |
performance of acute versus antecedent patient characteristics for 1-year mortality prediction during intensive care unit admission: a national cohort study |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2020-06-01 |
description |
Abstract Background Multiple factors contribute to mortality after ICU, but it is unclear how the predictive value of these factors changes during ICU admission. We aimed to compare the changing performance over time of the acute illness component, antecedent patient characteristics, and ICU length of stay (LOS) in predicting 1-year mortality. Methods In this retrospective observational cohort study, the discriminative value of four generalized mixed-effects models was compared for 1-year and hospital mortality. Among patients with increasing ICU LOS, the models included (a) acute illness factors and antecedent patient characteristics combined, (b) acute component only, (c) antecedent patient characteristics only, and (d) ICU LOS. For each analysis, discrimination was measured by area under the receiver operating characteristics curve (AUC), calculated using the bootstrap method. Statistical significance between the models was assessed using the DeLong method (p value < 0.05). Results In 400,248 ICU patients observed, hospital mortality was 11.8% and 1-year mortality 21.8%. At ICU admission, the combined model predicted 1-year mortality with an AUC of 0.84 (95% CI 0.84–0.84). When analyzed separately, the acute component progressively lost predictive power. From an ICU admission of at least 3 days, antecedent characteristics significantly exceeded the predictive value of the acute component for 1-year mortality, AUC 0.68 (95% CI 0.68–0.69) versus 0.67 (95% CI 0.67–0.68) (p value < 0.001). For hospital mortality, antecedent characteristics outperformed the acute component from a LOS of at least 7 days, comprising 7.8% of patients and accounting for 52.4% of all bed days. ICU LOS predicted 1-year mortality with an AUC of 0.52 (95% CI 0.51–0.53) and hospital mortality with an AUC of 0.54 (95% CI 0.53–0.55) for patients with a LOS of at least 7 days. Conclusions Comparing the predictive value of factors influencing 1-year mortality for patients with increasing ICU LOS, antecedent patient characteristics are more predictive than the acute component for patients with an ICU LOS of at least 3 days. For hospital mortality, antecedent patient characteristics outperform the acute component for patients with an ICU LOS of at least 7 days. After the first week of ICU admission, LOS itself is not predictive of hospital nor 1-year mortality. |
topic |
Intensive care Mortality Prognosis Advance care planning Long-term outcomes Critical illness |
url |
http://link.springer.com/article/10.1186/s13054-020-03017-y |
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