Journal of Clinical Medicine
Prognosis Prediction in Adult Intensive Care—A Critical Analysis
By P. Liberski, Szymon Czajka, Krzysztof Żerdziński and 1 others.
Abstract
Background
Prognosis prediction in adult intensive care units (ICUs) guides clinical decision-making, realistic goal-setting with families, and resource allocation, but is challenged by the marked heterogeneity of critically ill patients in multi-speciality wards.
Methods
This narrative review critically analyses commonly used prognostic scoring systems by clinical application timeline.
Results
Admission prognostic models, including the Acute Physiology and Chronic Health Evaluation (APACHE II/III/IV), Simplified Acute Physiology Score (SAPS II/SAPS 3) and Mortality Probability Model (MPM), estimate in-hospital mortality from acute physiological derangement and comorbidity; the Clinical Frailty Scale (CFS) adds prognostic value. During the ICU stay, organ dysfunction is tracked with the Sequential Organ Failure Assessment (SOFA/SOFA-2), designed for repeated reassessment, and the Multiple Organ Dysfunction Score (MODS), while the Therapeutic Intervention Scoring System (TISS-28) quantifies nursing workload. At discharge, the Barthel Index, Glasgow Outcome Scale (GOS) and Cerebral Performance Category (CPC) measure functional independence and neurological outcome. Admission-based mortality models use an initial assessment window and may require local recalibration, and discrimination alone does not establish clinical utility.