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. 2020 Nov 4;7(1):e589.
doi: 10.1002/ams2.589. eCollection 2020 Jan-Dec.

Utility of a prediction model for delirium in intensive care unit patients (PRE-DELIRIC) in mechanically ventilated patients with sepsis

Kyohei Miyamoto  1 , Tsuyoshi Nakashima  1 , Nozomu Shima  1 , Seiya Kato  1 , Yu Kawazoe  2 , Takeshi Morimoto  3 , Yoshinori Ohta  4 , Hitoshi Yamamura  5 ; DESIRE Trial Investigators
Collaborators, Affiliations

Utility of a prediction model for delirium in intensive care unit patients (PRE-DELIRIC) in mechanically ventilated patients with sepsis

Kyohei Miyamoto et al. Acute Med Surg. .

Abstract

Aim: Delirium frequently develops in patients with sepsis during their intensive care unit (ICU) stay, which is associated with increased morbidity and mortality. A prediction model for delirium in patients in ICU, PRE-DELIRIC, has been utilized in overall ICU patients, but its utility is uncertain among patients with sepsis. This study aims to examine the utility of PRE-DELIRIC to predict delirium in mechanically ventilated patients with sepsis.

Methods: This is a post hoc analysis of a randomized clinical trial in eight Japanese ICUs, which aimed to evaluate the sedative strategy with/without dexmedetomidine in adult mechanically ventilated patients with sepsis. The Confusion Assessment Method for the ICU was used every day to assess for delirium throughout their ICU stay. We excluded patients who were delirious on the first day of ICU, those who were under sustained coma throughout their ICU stay, and those who stayed in the ICU less than 24 h. The discriminative ability of PRE-DELIRIC was evaluated by measuring the area under the receiver operating characteristic curve (AUROC).

Results: Of the 201 patients enrolled in the trial, we analyzed 158 patients. The mean age was 69.4 ± 14.0 years, and 99 patients (63%) were men. Delirium occurred at least once during the ICU stay of 63 patients (40%). The AUROC of PRE-DELIRIC was 0.60 (95% confidence interval, 0.50-0.69). Subgroup analyses indicated that PRE-DELIRIC was useful in those with Sequential Organ Failure Assessment score >8 with AUROC of 0.65 (95% confidence interval, 0.51-0.77).

Conclusions: The PRE-DELIRIC model could not predict delirium in mechanically ventilated patients with sepsis.

Keywords: Clinical prediction rule; PRE‐DELIRIC; delirium; mechanical ventilation; sepsis.

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Conflict of interest statement

Approval of the research protocol: This study was a post hoc analysis of the DESIRE trial, which was a randomized controlled trial undertaken among eight ICUs in Japan. The participating institutions were Osaka City University, Osaka City General Hospital, Hyogo College of Medicine, Saga University Hospital, National Hospital Organization Kyoto Medical Center, Sapporo Medical University, Yamaguchi Grand Medical Center, and Wakayama Medical University. The ethical review boards of all relevant institutions approved the study protocol. Informed consent: Written informed consent was obtained from all participants or legally authorized guardians before study enrollment. Registry and registration no. of the trial: This trial was registered on ClinicalTrials.gov (NCT01760967) on 1 January, 2013. Animal studies: N/A. Conflict of interests: None.

Figures

Fig. 1
Fig. 1
Patient flowchart. DESIRE, Dexmedetomidine for Sepsis in Intensive Care Unit Randomized Evaluation; ICU, intensive care unit.
Fig. 2
Fig. 2
Receiver operating characteristic curve of a prediction model for delirium in intensive care unit patients (PRE‐DELIRIC) in mechanically ventilated patients with sepsis. The area under the receiver operating characteristic curve of PRE‐DELIRIC for predicting delirium is 0.60 (95% confidence interval, 0.50–0.69).
Fig. 3
Fig. 3
Area under the receiver operating characteristic curve (AUROC) of a prediction model for delirium in intensive care unit patients (PRE‐DELIRIC) in each subgroup of mechanically ventilated patients with sepsis. Organ failure is defined as Sequential Organ Failure Assessment (SOFA) subscore ≥3. The numbers of patients with liver failure (n = 1) and coagulation failure (n = 13) were too small to undertake subgroup analyses. Data are shown as AUROC (95% confidence interval). CNS, central nervous system.
See this image and copyright information in PMC

References

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