Patients being discharged from the intensive care unit (ICU) have variable risks of subsequent readmission or death; however, there is limited understanding of how to predict individual patient risk. We sought to derive risk prediction models for ICU readmission or death after ICU discharge to guide clinician decision-making.
Systematic review and meta-analysis to identify risk factors. Development and validation of risk prediction models using two retrospective cohorts of patients discharged alive from medical-surgical ICUs (n = 3 ICUs, n = 11,291 patients; n = 14 ICUs, n = 11,400 patients). Models were developed using literature and data-derived weighted coefficients.
Sixteen variables identified from the systematic review were used to develop four risk prediction models. In the validation cohort there were 795 (7%) patients who were re-admitted to ICU and 703 (7%) patients who died after ICU discharge. The area under the curve (AUROC) for ICU readmission for the literature (0.615 [95%CI: 0.593, 0.637]) and data (0.652 [95%CI: 0.631, 0.674]) weighted models showed poor discrimination. The AUROC for death after ICU discharge for the literature (0.708 [95%CI: 0.687, 0.728]) and local data weighted (0.752 [95%CI: 0.733, 0.770]) models showed good discrimination. The negative predictive values for ICU readmission and death after ICU discharge ranged from 94%-98%.
Identifying risk factors and weighting coefficients using systematic review and meta-analysis to develop prediction models is feasible and can identify patients at low risk of ICU readmission or death after ICU discharge.