Amerongen Hilde van Nieuw, Stapel Sandra, Spijkstra Jan Jaap, Ouweneel Dagmar, Schenk Jimmy
Hilde van Nieuw Amerongen is a registered nurse and clinical epidemiologist, Department of Intensive Care, Amsterdam UMC (VUmc), Amsterdam, the Netherlands.
Sandra Stapel is an intensivist, Department of Intensive Care, Amsterdam UMC (VUmc), Amsterdam, the Netherlands.
Am J Crit Care. 2023 Jan 1;32(1):43-50. doi: 10.4037/ajcc2023213.
Delirium is a severe complication in critical care patients. Accurate prediction could facilitate determination of which patients are at risk. In the past decade, several delirium prediction models have been developed.
To compare the prognostic accuracy of the PRE-DELIRIC, E-PRE-DELIRIC, and Lanzhou models, and to investigate the difference in prognostic accuracy of the PRE-DELIRIC model between patients receiving and patients not receiving mechanical ventilation.
This retrospective study involved adult patients admitted to the intensive care unit during a 2-year period. Delirium was assessed by using the Confusion Assessment Method for the Intensive Care Unit or any administered dose of haloperidol or quetiapine. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC); values were compared using the DeLong test.
The study enrolled 1353 patients. The AUC values were calculated as 0.716 (95% CI, 0.688-0.745), 0.681 (95% CI, 0.650-0.712), and 0.660 (95% CI, 0.629-0.691) for the PRE-DELIRIC, E-PRE-DELIRIC, and Lanzhou models, respectively. The difference in model discrimination was statistically significant for comparison of the PRE-DELIRIC with the E-PRE-DELIRIC (AUC difference, 0.035; P = .02) and Lanzhou models (AUC difference, 0.056; P < .001). In the PRE-DELIRIC model, the AUC was 0.711 (95% CI, 0.680-0.743) for patients receiving mechanical ventilation and 0.664 (95% CI, 0.586-0.742) for those not receiving it (difference, 0.047; P = .27).
Statistically significant differences in prognostic accuracy were found between delirium prediction models. The PRE-DELIRIC model was the best-performing model and can be used in patients receiving or not receiving mechanical ventilation.
谵妄是重症监护患者的一种严重并发症。准确的预测有助于确定哪些患者处于风险之中。在过去十年中，已经开发了几种谵妄预测模型。
比较PRE-DELIRIC、E-PRE-DELIRIC和兰州模型的预后准确性，并研究接受机械通气和未接受机械通气患者中PRE-DELIRIC模型预后准确性的差异。
这项回顾性研究纳入了在两年期间入住重症监护病房的成年患者。使用重症监护病房的意识模糊评估方法或任何剂量的氟哌啶醇或喹硫平来评估谵妄。通过计算受试者工作特征曲线下面积（AUC）来评估模型的辨别力；使用德龙检验比较数值。
该研究纳入了1353例患者。PRE-DELIRIC、E-PRE-DELIRIC和兰州模型的AUC值分别计算为0.716（95%CI，0.688-0.745）、0.681（95%CI，0.650-0.712）和0.660（95%CI，0.629-0.691）。PRE-DELIRIC与E-PRE-DELIRIC模型比较（AUC差异，0.035；P = 0.02）以及与兰州模型比较（AUC差异，0.056；P < 0.001）时，模型辨别力的差异具有统计学意义。在PRE-DELIRIC模型中，接受机械通气患者的AUC为0.711（95%CI，0.680-0.743），未接受机械通气患者的AUC为0.664（95%CI，0.586-0.742）（差异，0.047；P = 0.27）。
谵妄预测模型之间在预后准确性方面存在统计学显著差异。PRE-DELIRIC模型是表现最佳的模型，可用于接受或未接受机械通气的患者。
