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Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study

BACKGROUND: ICU risk assessment tools, routinely used for predicting population outcomes, are not recommended for evaluating individual risk. The state of health of single patients is mostly subjectively assessed to inform relatives and presumably to decide on treatment decisions. However, little is...

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Autores principales: Boeck, Lucas, Pargger, Hans, Schellongowski, Peter, Luyt, Charles-Edouard, Maggiorini, Marco, Jahn, Kathleen, Muller, Grégoire, Lötscher, Rene, Bucher, Evelyne, Cueni, Nadine, Staudinger, Thomas, Chastre, Jean, Siegemund, Martin, Tamm, Michael, Stolz, Daiana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10114386/
https://www.ncbi.nlm.nih.gov/pubmed/37076881
http://dx.doi.org/10.1186/s13054-023-04381-1
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author Boeck, Lucas
Pargger, Hans
Schellongowski, Peter
Luyt, Charles-Edouard
Maggiorini, Marco
Jahn, Kathleen
Muller, Grégoire
Lötscher, Rene
Bucher, Evelyne
Cueni, Nadine
Staudinger, Thomas
Chastre, Jean
Siegemund, Martin
Tamm, Michael
Stolz, Daiana
author_facet Boeck, Lucas
Pargger, Hans
Schellongowski, Peter
Luyt, Charles-Edouard
Maggiorini, Marco
Jahn, Kathleen
Muller, Grégoire
Lötscher, Rene
Bucher, Evelyne
Cueni, Nadine
Staudinger, Thomas
Chastre, Jean
Siegemund, Martin
Tamm, Michael
Stolz, Daiana
author_sort Boeck, Lucas
collection PubMed
description BACKGROUND: ICU risk assessment tools, routinely used for predicting population outcomes, are not recommended for evaluating individual risk. The state of health of single patients is mostly subjectively assessed to inform relatives and presumably to decide on treatment decisions. However, little is known how subjective and objective survival estimates compare. METHODS: We performed a prospective cohort study in mechanically ventilated critically ill patients across five European centres, assessed 62 objective markers and asked the clinical staff to subjectively estimate the probability of surviving 28 days. RESULTS: Within the 961 included patients, we identified 27 single objective predictors for 28-day survival (73.8%) and pooled them into predictive groups. While patient characteristics and treatment models performed poorly, the disease and biomarker models had a moderate discriminative performance for predicting 28-day survival, which improved for predicting 1-year survival. Subjective estimates of nurses (c-statistic [95% CI] 0.74 [0.70–0.78]), junior physicians (0.78 [0.74–0.81]) and attending physicians (0.75 [0.72–0.79]) discriminated survivors from non-survivors at least as good as the combination of all objective predictors (c-statistic: 0.67–0.72). Unexpectedly, subjective estimates were insufficiently calibrated, overestimating death in high-risk patients by about 20% in absolute terms. Combining subjective and objective measures refined discrimination and reduced the overestimation of death. CONCLUSIONS: Subjective survival estimates are simple, cheap and similarly discriminative as objective models; however, they overestimate death risking that live-saving therapies are withheld. Therefore, subjective survival estimates of individual patients should be compared with objective tools and interpreted with caution if not agreeing. Trial registration ISRCTN ISRCTN59376582, retrospectively registered October 31st 2013. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-023-04381-1.
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spelling pubmed-101143862023-04-20 Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study Boeck, Lucas Pargger, Hans Schellongowski, Peter Luyt, Charles-Edouard Maggiorini, Marco Jahn, Kathleen Muller, Grégoire Lötscher, Rene Bucher, Evelyne Cueni, Nadine Staudinger, Thomas Chastre, Jean Siegemund, Martin Tamm, Michael Stolz, Daiana Crit Care Research BACKGROUND: ICU risk assessment tools, routinely used for predicting population outcomes, are not recommended for evaluating individual risk. The state of health of single patients is mostly subjectively assessed to inform relatives and presumably to decide on treatment decisions. However, little is known how subjective and objective survival estimates compare. METHODS: We performed a prospective cohort study in mechanically ventilated critically ill patients across five European centres, assessed 62 objective markers and asked the clinical staff to subjectively estimate the probability of surviving 28 days. RESULTS: Within the 961 included patients, we identified 27 single objective predictors for 28-day survival (73.8%) and pooled them into predictive groups. While patient characteristics and treatment models performed poorly, the disease and biomarker models had a moderate discriminative performance for predicting 28-day survival, which improved for predicting 1-year survival. Subjective estimates of nurses (c-statistic [95% CI] 0.74 [0.70–0.78]), junior physicians (0.78 [0.74–0.81]) and attending physicians (0.75 [0.72–0.79]) discriminated survivors from non-survivors at least as good as the combination of all objective predictors (c-statistic: 0.67–0.72). Unexpectedly, subjective estimates were insufficiently calibrated, overestimating death in high-risk patients by about 20% in absolute terms. Combining subjective and objective measures refined discrimination and reduced the overestimation of death. CONCLUSIONS: Subjective survival estimates are simple, cheap and similarly discriminative as objective models; however, they overestimate death risking that live-saving therapies are withheld. Therefore, subjective survival estimates of individual patients should be compared with objective tools and interpreted with caution if not agreeing. Trial registration ISRCTN ISRCTN59376582, retrospectively registered October 31st 2013. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-023-04381-1. BioMed Central 2023-04-19 /pmc/articles/PMC10114386/ /pubmed/37076881 http://dx.doi.org/10.1186/s13054-023-04381-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Boeck, Lucas
Pargger, Hans
Schellongowski, Peter
Luyt, Charles-Edouard
Maggiorini, Marco
Jahn, Kathleen
Muller, Grégoire
Lötscher, Rene
Bucher, Evelyne
Cueni, Nadine
Staudinger, Thomas
Chastre, Jean
Siegemund, Martin
Tamm, Michael
Stolz, Daiana
Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study
title Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study
title_full Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study
title_fullStr Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study
title_full_unstemmed Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study
title_short Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study
title_sort subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10114386/
https://www.ncbi.nlm.nih.gov/pubmed/37076881
http://dx.doi.org/10.1186/s13054-023-04381-1
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