Evidence map›Paper›PMID 37076881›Full record

ArticleCritical care (London, England)2023

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

Lucas Boeck, Hans Pargger, Peter Schellongowski, Charles-Edouard Luyt, Marco Maggiorini, Kathleen Jahn, Grégoire Muller, Rene Lötscher, Evelyne Bucher, Nadine Cueni and 5 more

Abstract read
In one paragraph

Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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0cells of the map it votes in
2citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Lucas BoeckDepartment of Clinical Research, University Hospital Basel, Basel, Switzerland. lucas.boeck@unibas.ch.
Hans ParggerIntensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland.
Peter SchellongowskiDepartment of Internal Medicine I, University Hospital Vienna, Vienna, Austria.
Charles-Edouard LuytMédecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Paris, France.
Marco MaggioriniDepartment of Internal Medicine, Intensive Care Unit, University Hospital Zürich, Zürich, Switzerland.
Kathleen JahnDepartment of Clinical Research, University Hospital Basel, Basel, Switzerland.
Grégoire MullerMédecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Paris, France.
Rene LötscherSurgical and Medical Intensive Care Medicine, Kantonsspital Baselland, Liestal, Switzerland.
Evelyne BucherIntensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland.
Nadine CueniIntensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland.
Thomas StaudingerDepartment of Internal Medicine I, University Hospital Vienna, Vienna, Austria.
Jean ChastreMédecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Paris, France.
Martin SiegemundDepartment of Clinical Research, University Hospital Basel, Basel, Switzerland.
Michael TammDepartment of Clinical Research, University Hospital Basel, Basel, Switzerland.
Daiana StolzDepartment of Clinical Research, University Hospital Basel, Basel, Switzerland. Daiana.stolz@usb.ch.

Funding

Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung PP00-P3_128412/1Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung PZ00P3_185792
6 · The paper itself

Abstract

backgroundICU 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.

methodsWe 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.

resultsWithin 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.

conclusionsSubjective 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.

Indexed as

Critical IllnessRespiration, ArtificialHumansModels, TheoreticalProspective StudiesRisk AssessmentCritical careModellingOutcomePersonalised medicineRisk stratificationScores

Identifiers

PMID37076881
PMCPMC10114386

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.