Mortality prediction models in the adult critically ill: A scoping review

Britt E. Keuning, Thomas Kaufmann, Renske Wiersema, Anders Granholm, Ville Pettila, Morten Hylander Moller, Christian Fynbo Christiansen, Jose Castela Forte, Harold Snieder, Frederik Keus, Rick G. Pleijhuis, Iwan C. C. van der Horst*, HEALICS consortium

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background Mortality prediction models are applied in the intensive care unit (ICU) to stratify patients into different risk categories and to facilitate benchmarking. To ensure that the correct prediction models are applied for these purposes, the best performing models must be identified. As a first step, we aimed to establish a systematic review of mortality prediction models in critically ill patients. Methods Mortality prediction models were searched in four databases using the following criteria: developed for use in adult ICU patients in high-income countries, with mortality as primary or secondary outcome. Characteristics and performance measures of the models were summarized. Performance was presented in terms of discrimination, calibration and overall performance measures presented in the original publication. Results In total, 43 mortality prediction models were included in the final analysis. In all, 15 models were only internally validated (35%), 13 externally (30%) and 10 (23%) were both internally and externally validated by the original researchers. Discrimination was assessed in 42 models (98%). Commonly used calibration measures were the Hosmer-Lemeshow test (60%) and the calibration plot (28%). Calibration was not assessed in 11 models (26%). Overall performance was assessed in the Brier score (19%) and the Nagelkerke's R-2 (4.7%). Conclusions Mortality prediction models have varying methodology, and validation and performance of individual models differ. External validation by the original researchers is often lacking and head-to-head comparisons are urgently needed to identify the best performing mortality prediction models for guiding clinical care and research in different settings and populations.

Original languageEnglish
Pages (from-to)424-442
Number of pages19
JournalActa Anaesthesiologica Scandinavica
Volume64
Issue number4
Early online date26 Dec 2019
DOIs
Publication statusPublished - Apr 2020

Keywords

  • critical care
  • intensive care unit
  • mortality prediction model
  • performance
  • risk prediction
  • scoping review
  • INTENSIVE-CARE-UNIT
  • NEW-ZEALAND RISK
  • HOSPITAL MORTALITY
  • SAPS-II
  • PROGNOSTIC MODEL
  • ACUTE PHYSIOLOGY
  • ICU PATIENTS
  • INTERNAL VALIDATION
  • PROBABILITY-MODELS
  • APACHE-II

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