Validation of PREdiction of DELIRium in ICu patients (PRE-DELIRIC) among patients in intensive care units: A retrospective cohort study.
BACKGROUND
An intensive care unit (ICU) delirium prediction tool, PREdiction of DELIRium in ICu patients (PRE-DELIRIC), has been developed and calibrated in a multinational project. However, there is a lack of evidence regarding the predictive ability of the PRE-DELIRIC among Chinese ICU patients.


AIM
To evaluate the predictive validity (discrimination and calibration) of PRE-DELIRIC.


DESIGN
This is a retrospective cohort study.


METHODS
A retrospective cohort study was conducted. Consecutive participants (a) admitted to the ICU for ≥24 hours, (b) aged ≥18 years, and (c) admitted to the ICU for the first time were included. Ten predictors (age, APACHE-II, urgent and admission category, urea level, metabolic acidosis, infection, coma, sedation, and morphine use) assessed within 24 hours upon ICU admission were assessed. Delirium was assessed using the Confusion Assessment Method for ICU. Outcomes included ICU length of stay and mortality. Discrimination and calibration were determined by the areas under the receiver operating characteristic curve (AUROC), box plot, and calibration plot.


RESULTS
A total of 375 ICU patients were included, with 44.0% of patients being delirious. Delirium was significantly associated with age, PRE-DELIRIC score, ICU length of stay, and mortality. The AUROC was 0.81 (95% confidence interval, 0.77-0.86). The optimal cut-off point identified by max Youden index was 49%. The calibration plot of pooled data demonstrated a calibration slope of 0.894 and an intercept of -0.178.


CONCLUSIONS
The PRE-DELIRIC has high predictive value and is suggested to be adopted in ICUs for early initiation of preventive interventions against delirium among high-risk patients.


RELEVANCE TO CLINICAL PRACTICE
Clinicians can adopt the PRE-DELIRIC among ICU patients to screen patients at high risk of developing delirium. Early initiative interventions could be implemented to reduce the negative impacts of ICU delirium.
['Liang|Surui|S|0000-0003-1820-5867', 'Chau|Janita Pak Chun|JPC|', 'Lo|Suzanne Hoi Shan|SHS|', 'Bai|Liping|L|', 'Yao|Li|L|', 'Choi|Kai Chow|KC|']
D018806:APACHE D000293:Adolescent D000328:Adult D003422:Critical Care D003693:Delirium D006801:Humans D007362:Intensive Care Units D012189:Retrospective Studies
delirium ICU prevention PREDELIRIC risk factor