Accuracy of a Risk Alert Threshold for ICU Hypoglycemia: Retrospective Analysis of Alert Performance and Association With Clinical Deterioration Events.

Autor:	Horton WB; Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA., Hannah EE; Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Morales FL; University of Virginia School of Medicine, Charlottesville, VA., Chaney CR; Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA., Krahn KN; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA., Chernyavskiy P; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA.; Division of Biostatistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA., Clark MT; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA.; Nihon Kohden Digital Health Solutions, Inc, Irvine, CA., Moorman JR; Center for Advanced Medical Analytics, University of Virginia, Charlottesville, VA.; Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2023 Jan 01; Vol. 51 (1), pp. 136-140. Date of Electronic Publication: 2022 Nov 03.
DOI:	10.1097/CCM.0000000000005713
Abstrakt:	Objectives: To quantify the accuracy of and clinical events associated with a risk alert threshold for impending hypoglycemia during ICU admissions. Design: Retrospective electronic health record review of clinical events occurring greater than or equal to 1 and less than or equal to 12 hours after the hypoglycemia risk alert threshold was met. Setting: Adult ICU admissions from June 2020 through April 2021 at the University of Virginia Medical Center. Patients: Three hundred forty-two critically ill adults that were 63.5% male with median age 60.8 years, median weight 79.1 kg, and median body mass index of 27.5 kg/m2. Interventions: Real-world testing of our validated predictive model as a clinical decision support tool for ICU hypoglycemia. Measurements and Main Results: We retrospectively reviewed 350 hypothetical alerts that met inclusion criteria for analysis. The alerts correctly predicted 48 cases of level 1 hypoglycemia that occurred greater than or equal to 1 and less than or equal to 12 hours after the alert threshold was met (positive predictive value = 13.7%). Twenty-one of these 48 cases (43.8%) involved level 2 hypoglycemia. Notably, three myocardial infarctions, one medical emergency team call, 19 deaths, and 20 arrhythmias occurred greater than or equal to 1 and less than or equal to 12 hours after an alert threshold was met. Conclusions: Alerts generated by a validated ICU hypoglycemia prediction model had a positive predictive value of 13.7% for real-world hypoglycemia events. This proof-of-concept result suggests that the predictive model offers clinical value, but further prospective testing is needed to confirm this. Competing Interests: Dr. Horton received support for article research from the University of Virginia Launchpad for Diabetes and the Frederick Thomas Advanced Medical Analytics Fund. Dr. Clark received funding from Nihon Kohden Digital Health Solutions, Inc; he disclosed that he is employed as a Principal Software Engineer and receives salary from Nihon Kohden Digital Health Solutions, Inc, and that he was employed by and owned stock in Advanced Medical Predictive Devices, Diagnostics, and Displays, Inc (AMP3D), which was acquired by Nihon Kohden in August 2021. Dr. Moorman disclosed that he was a shareholder in AMP3D, Inc, is a consultant for Nihon Kohden Digital Health Solutions, and owns stock in Medical Predictive Science Corporation. He is a consultant for Nihon Kohden Digital Health Solutions, Inc., with proceeds donated to the University of Virginia. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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