Validation of PREdiction of DELIRium in ICu patients (PRE‐DELIRIC) among patients in intensive care units: A retrospective cohort study

Abstract

Background: An intensive care unit (ICU) delirium prediction tool, PREdiction of DELIRium in ICu patients (PRE-DELIRIC), has been developed and calibrated in a multinational project. However, there is a lack of evidence regarding the predictive ability of the PRE-DELIRIC among Chinese ICU patients.Aim: To evaluate the predictive validity (discrimination and calibration) of PRE- DELIRIC.Design: This is a retrospective cohort study.Methods: A retrospective cohort study was conducted. Consecutive participants (a) admitted to the ICU for ≥24 hours, (b) aged ≥18 years, and (c) admitted to the ICU for the first time were included. Ten predictors (age, APACHE-II, urgent and admission category, urea level, metabolic acidosis, infection, coma, sedation, and morphine use) assessed within 24 hours upon ICU admission were assessed. Delirium was assessed using the Confusion Assessment Method for ICU. Outcomes included ICU length of stay and mortality. Discrimination and calibration were determined by the areas under the receiver operating characteristic curve (AUROC), box plot, and calibration plot.Results: A total of 375 ICU patients were included, with 44.0% of patients being delirious. Delirium was significantly associated with age, PRE-DELIRIC score, ICU length of stay, and mortality. The AUROC was 0.81 (95% confidence interval, 0.77-0.86). The optimal cut-off point identified by max Youden index was 49%. The calibration plot of pooled data demonstrated a calibration slope of 0.894 and an intercept of −0.178. Conclusions:The PRE-DELIRIC has high predictive value and is suggested to be adopted in ICUs for early initiation of preventive interventions against delirium among high-risk patients.Relevance to clinical practice: Clinicians can adopt the PRE-DELIRIC among ICU patients to screen patients at high risk of developing delirium. Early initiative interventions could be implemented to reduce the negative impacts of ICU delirium.

Calibration of the PREdiction of DELIRium in ICu Patients (PRE-DELIRIC) Score in a Cohort of Critically Ill Patients

“…These factors include age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, admission group, coma, infection, metabolic acidosis, sedatives and morphine, urea concentration, and urgent admission. Since its development in 2012, several authors have validated the PRE-DELIRIC score in several countries, 17 yielding good discrimination and calibration ability 5,14 . Recently, studies on the Chinese population have reported an area under the receiver operating characteristic curve (AUROC) of 0.81, with similar findings from studies performed across 7 European countries 14,18 .…”

What is in this special issue on delirium?

“…Its validity and predictive ability have been evaluated in several countries. 15,16 Liang et al 17 in this issue add to this body of knowledge by presenting a retrospective cohort study aimed at assessing the predictive ability of PRE-DELIRIC among Chinese ICU patients. On the basis of sample size calculations, the study included data from 375 patients admitted to a surgical ICU in Guangzhou and a general ICU in Lanzhou over a 7-month period.…”

Implementation of ABCDEF care bundle in intensive care units: A cross‐sectional survey

“…A prospective study conducted in the surgical, cardiovascular surgical, and trauma surgical ICUs in an affiliated hospital of a medical university in Mainland China reported that 27% (81/400) of the patients developed delirium 7 . Another recent retrospective study conducted in two affiliated hospitals of universities in Mainland China revealed that 44% (165/375) of the patients (staying in ICU for over 24 hours) developed delirium 8 …”