Predictors of death and new disability after critical illness: a multicentre prospective cohort study

on behalf of the PREDICT Study Investigators

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Abstract

Purpose: This study aimed to determine the prevalence and predictors of death or new disability following critical illness. Methods: Prospective, multicentre cohort study conducted in six metropolitan intensive care units (ICU). Participants were adults admitted to the ICU who received more than 24 h of mechanical ventilation. The primary outcome was death or new disability at 6 months, with new disability defined by a 10% increase in the WHODAS 2.0. Results: Of 628 patients with the primary outcome available (median age of 62 [49–71] years, 379 [61.0%] had a medical admission and 370 (58.9%) died or developed new disability by 6 months. Independent predictors of death or new disability included age [OR 1.02 (1.01–1.03), P = 0.001], higher severity of illness (APACHE III) [OR 1.02 (1.01–1.03), P < 0.001] and admission diagnosis. Compared to patients with a surgical admission diagnosis, patients with a cardiac arrest [OR (95% CI) 4.06 (1.89–8.68), P < 0.001], sepsis [OR (95% CI) 2.43 (1.32–4.47), P = 0.004], or trauma [OR (95% CI) 6.24 (3.07–12.71), P < 0.001] diagnosis had higher odds of death or new disability, while patients with a lung transplant [OR (95% CI) 0.21 (0.07–0.58), P = 0.003] diagnosis had lower odds. A model including these three variables had good calibration (Brier score 0.20) and acceptable discriminative power with an area under the receiver operating characteristic curve of 0.76 (95% CI 0.72–0.80). Conclusion: Less than half of all patients mechanically ventilated for more than 24 h were alive and free of new disability at 6 months after admission to ICU. A model including age, illness severity and admission diagnosis has acceptable discriminative ability to predict death or new disability at 6 months.

Original languageEnglish
Pages (from-to)772-781
Number of pages10
JournalIntensive Care Medicine
Volume47
Issue number7
DOIs
Publication statusPublished - 1 Jul 2021

Keywords

  • Disability
  • Intensive care
  • Mechanical ventilation
  • Outcome prediction
  • Recovery

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