• Britt E Keuning, Thomas Kaufmann, Renske Wiersema, Anders Granholm, Ville Pettilä, MøllerMorten HylanderMH0000-0002-6378-9673Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.Centre for Research in Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Christian Fynbo Christiansen, José Castela Forte, Harold Snieder, Frederik Keus, Rick G Pleijhuis, van der HorstIwan C CICC0000-0003-3891-8522Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Intensive Care, Maastricht University Medical Center+, Maastricht University, Ma, and HEALICS consortium.
• Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
• Acta Anaesthesiol Scand. 2020 Apr 1; 64 (4): 424-442.

BackgroundMortality prediction models are applied in the intensive care unit (ICU) to stratify patients into different risk categories and to facilitate benchmarking. To ensure that the correct prediction models are applied for these purposes, the best performing models must be identified. As a first step, we aimed to establish a systematic review of mortality prediction models in critically ill patients.MethodsMortality prediction models were searched in four databases using the following criteria: developed for use in adult ICU patients in high-income countries, with mortality as primary or secondary outcome. Characteristics and performance measures of the models were summarized. Performance was presented in terms of discrimination, calibration and overall performance measures presented in the original publication.ResultsIn total, 43 mortality prediction models were included in the final analysis. In all, 15 models were only internally validated (35%), 13 externally (30%) and 10 (23%) were both internally and externally validated by the original researchers. Discrimination was assessed in 42 models (98%). Commonly used calibration measures were the Hosmer-Lemeshow test (60%) and the calibration plot (28%). Calibration was not assessed in 11 models (26%). Overall performance was assessed in the Brier score (19%) and the Nagelkerke's R2 (4.7%).ConclusionsMortality prediction models have varying methodology, and validation and performance of individual models differ. External validation by the original researchers is often lacking and head-to-head comparisons are urgently needed to identify the best performing mortality prediction models for guiding clinical care and research in different settings and populations.© 2019 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

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