Porter Lucy L, Hazeleger Lotte, Bos Kirsten, Simons Koen S, van der Hoeven Johannes G, Yeghaian Melda, van der Woude Margaretha C E, van Santen Susanne, Rettig Thijs C D, de Vries Marijke, van den Boogaard Mark, Zegers Marieke
Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Intensive Care, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
Intensive Care Med. 2025 Aug 7. doi: 10.1007/s00134-025-08052-3.
PURPOSE: ICU patients differ in pre-ICU health status, comorbidities, and diagnosis, forming a heterogeneous population with diverse long-term outcomes. This study explored whether clustering ICU patients by demographic, pre-admission quality of life, and clinical data, rather than by diagnosis, could identify subgroups that are more informative for patient-centered outcomes post-ICU. METHODS: Data from the MONITOR-IC prospective cohort study were used. Demographic, pre-admission quality of life, and clinical data from 2361 adult ICU survivors of six hospitals were used to identify clusters, using the k-prototypes algorithm. Data from five additional hospitals (n = 866) were used for external validation. Self-reported physical, mental, and cognitive functioning, and quality of life one year post-ICU were described. RESULTS: The four identified clusters differed significantly in long-term physical, mental, and cognitive functioning, and quality of life. Cluster-A (n = 204), characterized by a healthy pre-ICU status, high disease severity, low Glasgow Coma Scale, and long ICU stay, had a relatively high quality of life at one year, despite experiencing a mean decline from baseline. Cluster-B (n = 877), also a healthy group before admission but less severely ill at ICU admission, reported the best outcomes. Cluster-C (n = 632) included younger, mostly female patients with moderate impairments both pre- and one-year post-ICU. Cluster-D (n = 648), characterized by a low education level and poor baseline health, reported impaired outcomes one year post-ICU, although improved compared to their pre-admission status. External validation confirmed the generalizability of these results. CONCLUSION: This study identified and externally validated four distinct clusters of ICU patients by integrating both clinical and non-clinical data. These clusters, which differed in long-term physical, mental, and cognitive outcomes, challenge conventional disease-based classification, and support a multidimensional approach to define subgroups of ICU patients. TRIAL REGISTRATION: The MONITOR-IC study was registered at ClinicalTrials.gov: NCT03246334.
目的：重症监护病房（ICU）患者在入住ICU前的健康状况、合并症和诊断方面存在差异，形成了一个具有不同长期预后的异质性群体。本研究探讨了根据人口统计学、入院前生活质量和临床数据而非诊断对ICU患者进行聚类，是否能够识别出对以患者为中心的ICU后结局更具信息价值的亚组。 方法：使用了MONITOR-IC前瞻性队列研究的数据。来自六家医院的2361名成年ICU幸存者的人口统计学、入院前生活质量和临床数据，采用k-原型算法来识别聚类。另外五家医院（n = 866）的数据用于外部验证。描述了患者在ICU后一年自我报告的身体、心理和认知功能以及生活质量。 结果：所识别出的四个聚类在长期身体、心理和认知功能以及生活质量方面存在显著差异。A聚类（n = 204）的特征是入住ICU前健康状况良好、疾病严重程度高、格拉斯哥昏迷量表评分低且ICU住院时间长，尽管与基线相比平均有所下降，但在一年时生活质量相对较高。B聚类（n = 877）在入院前也是健康组，但在入住ICU时病情较轻，报告的结局最佳。C聚类（n = 632）包括年轻患者，大多数为女性，在入住ICU前和一年后均有中度损伤。D聚类（n = 648）的特征是教育水平低且基线健康状况差，在ICU后一年报告结局受损，尽管与入院前状态相比有所改善。外部验证证实了这些结果的可推广性。 结论：本研究通过整合临床和非临床数据，识别并在外部验证了四个不同的ICU患者聚类。这些聚类在长期身体、心理和认知结局方面存在差异，挑战了传统的基于疾病的分类方法，并支持采用多维度方法来定义ICU患者亚组。 试验注册：MONITOR-IC研究已在ClinicalTrials.gov注册：NCT03246334。
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