Department of Intensive Care Medicine, Radboud University Medical Center, P.O. 6101 Internal Post 710, 6500 HB, Nijmegen, The Netherlands,
Intensive Care Med. 2014 Mar;40(3):361-9. doi: 10.1007/s00134-013-3202-7. Epub 2014 Jan 18.
Recalibration and determining discriminative power, internationally, of the existing delirium prediction model (PRE-DELIRIC) for intensive care patients.
A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The ten predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea level, metabolic acidosis) were collected within 24 h after ICU admission. The confusion assessment method for the intensive care unit (CAM-ICU) was used to identify ICU delirium. CAM-ICU screening compliance and inter-rater reliability measurements were used to secure the quality of the data.
A total of 2,852 adult ICU patients were screened of which 1,824 (64%) were eligible for the study. Main reasons for exclusion were length of stay <1 day (19.1%) and sustained coma (4.1%). CAM-ICU compliance was mean (SD) 82 ± 16% and inter-rater reliability 0.87 ± 0.17. The median delirium incidence was 22.5% (IQR 12.8-36.6%). Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the eight participating centers remained good: 0.77 (95% CI 0.74-0.79). The linear predictor and intercept of the prediction rule were adjusted and resulted in improved re-calibration of the PRE-DELIRIC model.
In this multinational study, we recalibrated the PRE-DELIRIC model. Despite differences in the incidence of predictors between the centers in the different countries, the performance of the PRE-DELIRIC-model remained good. Following validation of the PRE-DELIRIC model, it may facilitate implementation of strategies to prevent delirium and aid improvements in delirium management of ICU patients.
对现有的 ICU 患者谵妄预测模型（PRE-DELIRIC）进行国际重新校准和判别能力的确定。
在六个国家的八个 ICU 中进行了一项前瞻性多中心队列研究。在 ICU 入住后 24 小时内收集了 10 个预测因素（年龄、APACHE-II、紧急和入院类别、感染、昏迷、镇静、吗啡使用、尿素水平、代谢性酸中毒）。使用 ICU 意识模糊评估方法（CAM-ICU）来识别 ICU 谵妄。CAM-ICU 筛查的依从性和组内一致性测量用于确保数据的质量。
共筛查了 2852 名成年 ICU 患者，其中 1824 名（64%）符合研究条件。排除的主要原因是入住时间<1 天（19.1%）和持续昏迷（4.1%）。CAM-ICU 的依从性为 82±16%，组内一致性为 0.87±0.17。谵妄发生率的中位数为 22.5%（IQR 12.8-36.6%）。尽管所有 10 个预测因素在中心之间的发生率存在显著差异，但 8 个参与中心的接收者操作特征（ROC）曲线下面积（AUROC）仍然较好：0.77（95%CI 0.74-0.79）。调整了预测规则的线性预测因子和截距，从而改善了 PRE-DELIRIC 模型的重新校准。
在这项多中心研究中，我们对 PRE-DELIRIC 模型进行了重新校准。尽管不同国家中心的预测因素发生率存在差异，但 PRE-DELIRIC 模型的性能仍然良好。在 PRE-DELIRIC 模型验证后，它可能有助于实施预防谵妄的策略，并有助于改善 ICU 患者的谵妄管理。
