Estimating long-term survival of critically ill patients: the PREDICT model.

Abstract

BACKGROUND:

Long-term survival outcome of critically ill patients is important in assessing effectiveness of new treatments and making treatment decisions. We developed a prognostic model for estimation of long-term survival of critically ill patients.

METHODOLOGY AND PRINCIPAL FINDINGS:

This was a retrospective linked data cohort study involving 11,930 critically ill patients who survived more than 5 days in a university teaching hospital in Western Australia. Older age, male gender, co-morbidities, severe acute illness as measured by Acute Physiology and Chronic Health Evaluation II predicted mortality, and more days of vasopressor or inotropic support, mechanical ventilation, and hemofiltration within the first 5 days of intensive care unit admission were associated with a worse long-term survival up to 15 years after the onset of critical illness. Among these seven pre-selected predictors, age (explained 50% of the variability of the model, hazard ratio [HR] between 80 and 60 years old = 1.95) and co-morbidity (explained 27% of the variability, HR between Charlson co-morbidity index 5 and 0 = 2.15) were the most important determinants. A nomogram based on the pre-selected predictors is provided to allow estimation of the median survival time and also the 1-year, 3-year, 5-year, 10-year, and 15-year survival probabilities for a patient. The discrimination (adjusted c-index = 0.757, 95% confidence interval 0.745-0.769) and calibration of this prognostic model were acceptable.

SIGNIFICANCE:

Age, gender, co-morbidities, severity of acute illness, and the intensity and duration of intensive care therapy can be used to estimate long-term survival of critically ill patients. Age and co-morbidity are the most important determinants of long-term prognosis of critically ill patients.

• Authors: Kwok M Ho, Matthew Knuiman, Judith Finn, Steven A Webb
• Journal: PloS one (PLoS One) Vol. 3 Issue 9 Pg. e3226 (Sep 17 2008) ISSN: 1932-6203 [Electronic] United States
• PMID: 18797505 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Cohort Studies
• Comorbidity
• Critical Care
• Critical Illness (mortality)
• Female
• Humans
• Male
• Middle Aged
• Models, Theoretical
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Treatment Outcome