Validation and Early Application of the ProVent Score in a Contemporary ICU Cohort

Abstract

Background

Prolonged mechanical ventilation (PMV) is associated with poor long-term outcomes. The ProVent14 score was developed to estimate one-year mortality among patients receiving mechanical ventilation for at least 14 days. However, contemporary validation of the model and its performance earlier during mechanical ventilation remain uncertain. We aimed to evaluate the validity of the ProVent14 score in a modern ICU cohort and assess its predictive performance when applied earlier during mechanical ventilation.

Methods

We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care (MIMIC-IV) database (2008-2022). Adult ICU admissions receiving at least seven days of mechanical ventilation were included. Patients with chronic neuromuscular disease, extensive burns, or chronic mechanical ventilation were excluded. Three non-mutually exclusive cohorts were constructed based on duration of ventilation (≥7,≥10, and ≥14 days). Predictors from the original ProVent14 model (age, platelet count, vasopressor use, hemodialysis requirement, and trauma admission status) were assessed at each time point. The primary outcome was one-year mortality from the onset of prolonged ventilation. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated using the Hosmer–Lemeshow test. Results: A total of 1344, 634, and 249 patients comprised the day-7, day-10, and day-14 cohorts, respectively. One-year mortality ranged from 64% to 67% across cohorts. The ProVent model demonstrated consistent discrimination at day 7, day 10, and day 14 (AUC 0.74, 0.72, and 0.71, respectively) with acceptable calibration (Hosmer–Lemeshow P-values 0.50, 0.18, and 0.21). Model performance remained stable across different study periods. Conclusions: The ProVent score maintains stable predictive performance in a contemporary ICU population. Similar discrimination and calibration at days 7 and 10 suggest that prognostic assessment may be feasible earlier during mechanical ventilation.