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

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.

Prognosticating the outcome of intensive care in older patients—a narrative review

“…Thus, younger and older individuals' views and expectations about intensive care may differ. Since the use of advanced directives is limited in many countries and the performance of tools for prognostications in these domains remains suboptimal [18], the ultimate prediction of ICU outcomes and the alignment of the subsequent decisions about LST with the patient's preferences are mostly left to the discretion of healthcare professionals or surrogate decision-makers. Their cultural and individual preferences can lead to substantial biases and misalignments of decisions regarding the patients' wishes [19][20][21][22].…”