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External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit

BACKGROUND: No data is available on delirium prediction models in the cardiac intensive care unit (CICU), although preexisting delirium prediction models [PREdiction of DELIRium in ICu patients (PRE-DELIRIC) and Early PREdiction of DELIRium in ICu patients (E-PRE-DELIRIC)] were developed and validat...

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Autores principales: Kim, Sung Eun, Ko, Ryoung-Eun, Na, Soo Jin, Chung, Chi Ryang, Choi, Ki Hong, Kim, Darae, Park, Taek Kyu, Lee, Joo Myung, Song, Young Bin, Choi, Jin-Oh, Hahn, Joo-Yong, Choi, Seung-Hyuk, Gwon, Hyeon-Cheol, Yang, Jeong Hoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9382019/
https://www.ncbi.nlm.nih.gov/pubmed/35990989
http://dx.doi.org/10.3389/fcvm.2022.947149
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author Kim, Sung Eun
Ko, Ryoung-Eun
Na, Soo Jin
Chung, Chi Ryang
Choi, Ki Hong
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Gwon, Hyeon-Cheol
Yang, Jeong Hoon
author_facet Kim, Sung Eun
Ko, Ryoung-Eun
Na, Soo Jin
Chung, Chi Ryang
Choi, Ki Hong
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Gwon, Hyeon-Cheol
Yang, Jeong Hoon
author_sort Kim, Sung Eun
collection PubMed
description BACKGROUND: No data is available on delirium prediction models in the cardiac intensive care unit (CICU), although preexisting delirium prediction models [PREdiction of DELIRium in ICu patients (PRE-DELIRIC) and Early PREdiction of DELIRium in ICu patients (E-PRE-DELIRIC)] were developed and validated based on a population admitted to the general intensive care unit (ICU). Therefore, we externally validated the usefulness of the PRE-DELIRIC and E-PRE-DELIRIC models and compared their predictive performance in patients admitted to the CICU. METHODS: A total of 2,724 patients admitted to the CICU were enrolled between September 2012 and December 2018. Delirium was defined as at least one positive Confusion Assessment Method for the ICU (CAM-ICU) which was screened at least once every 8 h. The PRE-DELIRIC value was calculated within 24 h of CICU admission, and the E-PRE-DELIRIC value was calculated at CICU admission. The predictive performance of the models was evaluated by using the area under the receiver operating characteristic (AUROC) curve, and the calibration slope was assessed graphically by plotting. RESULTS: Delirium occurred in 677 patients (24.8%) when the patients were assessed thrice daily until 7 days of the CICU stay. The AUROC curve for the prediction of delirium was significantly greater for PRE-DELIRIC values [0.84, 95% confidence interval (CI): 0.82–0.86] than for E-PRE-DELIRIC values (0.79, 95% CI: 0.77–0.80) [z score of −6.24 (p < 0.001)]. Net reclassification improvement for the prediction of delirium increased by 0.27 (95% CI: 0.21–0.32, p < 0.001). Calibration was acceptable in the PRE-DELIRIC model (Hosmer-Lemeshow p = 0.170) but not in the E-PRE-DELIRIC model (Hosmer-Lemeshow p < 0.001). CONCLUSION: Although both models have good predictive performance for the development of delirium, even in critically ill cardiac patients, the performance of the PRE-DELIRIC model might be superior to that of the E-PRE-DELIRIC model. Further studies are required to confirm our results and design a specific delirium prediction model for CICU patients.
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spelling pubmed-93820192022-08-18 External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit Kim, Sung Eun Ko, Ryoung-Eun Na, Soo Jin Chung, Chi Ryang Choi, Ki Hong Kim, Darae Park, Taek Kyu Lee, Joo Myung Song, Young Bin Choi, Jin-Oh Hahn, Joo-Yong Choi, Seung-Hyuk Gwon, Hyeon-Cheol Yang, Jeong Hoon Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: No data is available on delirium prediction models in the cardiac intensive care unit (CICU), although preexisting delirium prediction models [PREdiction of DELIRium in ICu patients (PRE-DELIRIC) and Early PREdiction of DELIRium in ICu patients (E-PRE-DELIRIC)] were developed and validated based on a population admitted to the general intensive care unit (ICU). Therefore, we externally validated the usefulness of the PRE-DELIRIC and E-PRE-DELIRIC models and compared their predictive performance in patients admitted to the CICU. METHODS: A total of 2,724 patients admitted to the CICU were enrolled between September 2012 and December 2018. Delirium was defined as at least one positive Confusion Assessment Method for the ICU (CAM-ICU) which was screened at least once every 8 h. The PRE-DELIRIC value was calculated within 24 h of CICU admission, and the E-PRE-DELIRIC value was calculated at CICU admission. The predictive performance of the models was evaluated by using the area under the receiver operating characteristic (AUROC) curve, and the calibration slope was assessed graphically by plotting. RESULTS: Delirium occurred in 677 patients (24.8%) when the patients were assessed thrice daily until 7 days of the CICU stay. The AUROC curve for the prediction of delirium was significantly greater for PRE-DELIRIC values [0.84, 95% confidence interval (CI): 0.82–0.86] than for E-PRE-DELIRIC values (0.79, 95% CI: 0.77–0.80) [z score of −6.24 (p < 0.001)]. Net reclassification improvement for the prediction of delirium increased by 0.27 (95% CI: 0.21–0.32, p < 0.001). Calibration was acceptable in the PRE-DELIRIC model (Hosmer-Lemeshow p = 0.170) but not in the E-PRE-DELIRIC model (Hosmer-Lemeshow p < 0.001). CONCLUSION: Although both models have good predictive performance for the development of delirium, even in critically ill cardiac patients, the performance of the PRE-DELIRIC model might be superior to that of the E-PRE-DELIRIC model. Further studies are required to confirm our results and design a specific delirium prediction model for CICU patients. Frontiers Media S.A. 2022-08-03 /pmc/articles/PMC9382019/ /pubmed/35990989 http://dx.doi.org/10.3389/fcvm.2022.947149 Text en Copyright © 2022 Kim, Ko, Na, Chung, Choi, Kim, Park, Lee, Song, Choi, Hahn, Choi, Gwon and Yang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Kim, Sung Eun
Ko, Ryoung-Eun
Na, Soo Jin
Chung, Chi Ryang
Choi, Ki Hong
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Gwon, Hyeon-Cheol
Yang, Jeong Hoon
External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit
title External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit
title_full External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit
title_fullStr External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit
title_full_unstemmed External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit
title_short External validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit
title_sort external validation and comparison of two delirium prediction models in patients admitted to the cardiac intensive care unit
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9382019/
https://www.ncbi.nlm.nih.gov/pubmed/35990989
http://dx.doi.org/10.3389/fcvm.2022.947149
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