• Dries van Sleeuwen, Marieke Zegers, Jordache Ramjith, Juliette K Cruijsberg, Koen S Simons, Daniëlle van Bommel, Dominique Burgers-Bonthuis, Julia Koeter, BisschopsLaurens L ALLADepartment of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands., Inge Janssen, RettigThijs C DTCDDepartment of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Amphia Hospital, Breda, The Netherlands., Johannes G van der Hoeven, Floris A van de Laar, and Mark van den Boogaard.
• Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
• Crit. Care Med. 2024 Feb 1; 52 (2): 200209200-209.

ObjectivesICU survivors often suffer from long-lasting physical, mental, and cognitive health problems after hospital discharge. As several interventions that treat or prevent these problems already start during ICU stay, patients at high risk should be identified early. This study aimed to develop a model for early prediction of post-ICU health problems within 48 hours after ICU admission.DesignProspective cohort study in seven Dutch ICUs.Setting/PatientsICU patients older than 16 years and admitted for greater than or equal to 12 hours between July 2016 and March 2020.InterventionsNone.Measurements And Main ResultsOutcomes were physical problems (fatigue or ≥ 3 new physical symptoms), mental problems (anxiety, depression, or post-traumatic stress disorder), and cognitive impairment. Patient record data and questionnaire data were collected at ICU admission, and after 3 and 12 months, of 2,476 patients. Several models predicting physical, mental, or cognitive problems and a composite score at 3 and 12 months were developed using variables collected within 48 hours after ICU admission. Based on performance and clinical feasibility, a model, PROSPECT, predicting post-ICU health problems at 3 months was chosen, including the predictors of chronic obstructive pulmonary disease, admission type, expected length of ICU stay greater than or equal to 2 days, and preadmission anxiety and fatigue. Internal validation using bootstrapping on data of the largest hospital ( n = 1,244) yielded a C -statistic of 0.73 (95% CI, 0.70-0.76). External validation was performed on data ( n = 864) from the other six hospitals with a C -statistic of 0.77 (95% CI, 0.73-0.80).ConclusionsThe developed and externally validated PROSPECT model can be used within 48 hours after ICU admission for identifying patients with an increased risk of post-ICU problems 3 months after ICU admission. Timely preventive interventions starting during ICU admission and follow-up care can prevent or mitigate post-ICU problems in these high-risk patients.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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