Evaluation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for the patients in the intensive care unit

Abstract

Introduction.Delirium not only compromises patient care, but is also associated with poorer outcomes: increased duration of mechanical ventilation, higher mortality, and greater long-term cognitive dysfunction. The PRE-DELIRIC model is a tool used to calculate the risk of the development of delirium. The classification of the patients into groups by risk allows efficient initiation of preventive measures. The goal of this study was to validate the PRE-DELIRIC model using the CAM-ICU (The Confusion Assessment Method for the Intensive Care Unit) method for the diagnosis of delirium.Materials and methods.Patients admitted to the University Hospital of Vilnius during February 2015 were enrolled. Every day, data were collected for APACHE-II and PRE-DELIRIC scores. Out of 167 patients, 38 (23%) were included and screened using the CAM-ICU method within 24 hours of admission to the ICU. We defined patients as having delirium when they had at least one positive CAM-ICU screening or haloperidol administration due to sedation. To validate the PRE-DELIRIC model, we calculated the area under receiver operating characteristic curve.Results.The mean age of the patients was 69.2 ± 17.2 years, 19 (50%) were male, APACHE-II mean score 18.0 ± 7.4 points. Delirium was diagnosed in 22 (58%) of 38 patients. Data used for validation of the PRE-DELIRIC model resulted in an area under the curve of 0.713 (p < 0.05, 95% CI 0.539–0.887); sensitivity and specificity for the patients with 20% risk were, accordingly, 77.3% and 50%; 40% risk – 45.5% and 81.3%, 60% – 36.4%, and 87.5%.Conclusions.The PRE-DELIRIC model predicted delirium in the patients within 24 hours of admission to the ICU. Preventive therapy could be efficiently targeted at high-risk patients if both of the methods are to be implemented.

Delirium

“…In the ICU, the PRE-DELIRIC model 68 , which is based on ten risk factors (age, APACHE-II score, admission group, coma, infection, metabolic acidosis, use of sedatives and morphine, urea concentration and urgent admission) identified within 24 hours of ICU admission, predicted delirium with an area under the receiver operating curve of 0.87 (95% CI 0.85-0.89) in the first 24 hours after admission to the ICU. The PRE-DELIRIC model showed excellent performance in clinical cohorts, including in studies from Lithuania, Scotland and Argentina [69][70][71] .…”

ICU Delirium-Prediction Models: A Systematic Review

“…Of the 18 included studies, 12 were primarily concerned with the development of new prediction models ( 28 – 39 ) and six with the validation of existing models ( 20 , 22 , 40 – 43 ) ( Table 1 ). These studies included 23 risk-prediction models, of which 12 were developed in the included studies.…”

“…Sample sizes ranged from 94 to 3,284 participants ( 33 , 34 ). Those studies that validated existing models had a sample size ranging from 38 to 2,178 participants ( 42 , 43 ). Delirium was most commonly assessed using CAM-ICU, though several studies used CAM ( 31 ), Nursing Delirium Screening Scale (NuDESC) ( 31 , 39 ), diagnostic and statistical manual of mental disorders (DSM) ( 20 , 36 ), and ICDSC ( 20 , 35 , 42 ).…”

Platelet-to-lymphocyte ratio as a predictive index for delirium in critically ill patients

“…Delirium is a common neuropsychiatric syndrome in the intensive care unit (ICU) that presents as impaired consciousness, cognition, and attention, [ 1 , 2 ] with a reported incidence that varies from 11% to 87%. [ 3 ] Previous studies indicated that delirium could contribute to prolonged mechanical ventilation duration and ICU length of stay (LOS), as well as a higher mortality rate.…”