{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T03:40:00Z","timestamp":1789962000024,"version":"4.0.1"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Intensive Care Unit (ICU) readmission and in-hospital mortality are critical indicators of patient outcomes following ICU discharge. Patients readmitted to the ICU often face worse prognosis, higher healthcare costs, and prolonged hospital stays. Identifying high-risk patients is essential for optimizing post-ICU care and resource allocation. Methods: This two-phase study included the following: (1) a retrospective analysis of ICU survivors in a mixed medical\u2013surgical ICU to identify risk factors associated with ICU readmission and in-hospital mortality, and (2) a prospective validation of a newly developed predictive model: the Worse Outcome Score (WOScore). Data collected included demographics, ICU admission characteristics, severity scores (SAPS II, SAPS III, APACHE II, SOFA), interventions, complications and discharge parameters. Results: Among 1.190 ICU survivors, 126 (10.6%) were readmitted to the ICU, and 192 (16.1%) died in hospital after ICU discharge. Key risk factors for ICU readmission included Diabetes Mellitus, SAPS III on admission, and ICU-acquired infections (Ventilator-Associated Pneumonia (VAP) and Catheter-Related Bloodstream Infection, (CRBSI)). Predictors of in-hospital mortality were identified: medical admission, high SAPS III score, high lactate level on ICU admission, tracheostomy, reduced GCS at discharge, blood transfusion, CRBSI, and Acute Kidney Injury (AKI) during ICU stay. The WOScore, developed based on the results above, demonstrated strong predictive ability (AUC: 0.845 derivation, 0.886 validation). A cut-off of 20 distinguished high-risk patients (sensitivity: 88.1%, specificity: 73.0%). Conclusions: ICU readmission and in-hospital mortality are influenced by patient severity, underlying comorbidities, and ICU-related complications. The WOScore provides an effective, easy-to-use risk stratification tool that can guide clinicians in identifying high-risk patients at ICU discharge and guide post-ICU interventions, potentially improving patients\u2019 outcomes and optimizing resource allocation. Further multi-center studies are necessary to validate the model in diverse healthcare settings.<\/jats:p>","DOI":"10.3390\/jpm15100479","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T07:57:27Z","timestamp":1759478247000},"page":"479","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["ICU Readmission and In-Hospital Mortality Rates for Patients Discharged from the ICU\u2014Risk Factors and Validation of a New Predictive Model: The Worse Outcome Score (WOScore)"],"prefix":"10.3390","volume":"15","author":[{"given":"Eleftherios","family":"Papadakis","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital of Heraklion, 71110 Heraklion, Greece"},{"name":"Medical School, University of Crete, 70013 Heraklion, Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasia","family":"Proklou","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital of Heraklion, 71110 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Kokkini","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital of Heraklion, 71110 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Papakitsou","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital of Heraklion, 71110 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9126-9376","authenticated-orcid":false,"given":"Ioannis","family":"Konstantinou","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital of Heraklion, 71110 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aggeliki","family":"Konstantinidi","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital of Heraklion, 71110 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Prinianakis","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital of Heraklion, 71110 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stergios","family":"Intzes","sequence":"additional","affiliation":[{"name":"Department of Management Science and Technology, Democritus University, 65404 Kavala, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianthi","family":"Symeonidou","sequence":"additional","affiliation":[{"name":"Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3323-5266","authenticated-orcid":false,"given":"Eumorfia","family":"Kondili","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital of Heraklion, 71110 Heraklion, Greece"},{"name":"Medical School, University of Crete, 70013 Heraklion, Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"van Sluisveld, N., Bakhshi-Raiez, F., de Keizer, N., Holman, R., Wester, G., Wollersheim, H., van der Hoeven, J.G., and Zegers, M. (2017). Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv. Res., 17.","DOI":"10.1186\/s12913-017-2234-z"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s13054-021-03465-0","article-title":"Death in hospital following ICU discharge: Insights from the LUNG SAFE study","volume":"25","author":"Madotto","year":"2021","journal-title":"Crit. Care"},{"key":"ref_3","first-page":"e62840","article-title":"Determinants of Readmission in the Intensive Care Unit: A Prospective Observational Study","volume":"16","author":"Kumar","year":"2024","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1513\/AnnalsATS.201611-851OC","article-title":"Readmission to the Intensive Care Unit: Incidence, Risk Factors, Resource Use, and Outcomes. A Retrospective Cohort Study","volume":"14","author":"Ponzoni","year":"2017","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"272","DOI":"10.12688\/wellcomeopenres.18381.3","article-title":"Incidence, risk and impact of ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study","volume":"7","author":"Aryal","year":"2025","journal-title":"Wellcome Open Res."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bekele, T.G., Melaku, B., Demisse, L.B., Abza, L.F., and Assen, A.S. (2024). Outcomes and factors associated with prolonged stays among patients admitted to adult intensive care unit in a resource-limited setting: A multicenter chart review. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-64911-x"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1097\/CCM.0000000000002563","article-title":"The Impact of Mortality on Total Costs Within the ICU","volume":"45","author":"Kramer","year":"2017","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1159\/000516297","article-title":"Factors and Outcomes of Intensive Care Unit Readmission in Elderly Patients","volume":"68","author":"Lee","year":"2022","journal-title":"Gerontology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/0310057X1504300206","article-title":"Efficacy of the APACHE II Score at ICU Discharge in Predicting Post-ICU Mortality and ICU Readmission in Critically Ill Surgical Patients","volume":"43","author":"Lee","year":"2015","journal-title":"Anaesth. Intensive Care."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"383","DOI":"10.2147\/RMHP.S399829","article-title":"Status and Risk Factors in Patients Requiring Unplanned Intensive Care Unit Readmission Within 48 Hours: A Retrospective Propensity-Matched Study in China","volume":"16","author":"Yin","year":"2023","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s40560-015-0096-1","article-title":"Risk prediction of ICU readmission in a mixed surgical and medical population","volume":"3","author":"Kareliusson","year":"2015","journal-title":"J. Intensive Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4266\/acc.2020.01144","article-title":"Risk factors for intensive care unit readmission after lung transplantation: A retrospective cohort study","volume":"36","author":"Kim","year":"2021","journal-title":"Acute Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/CCM.0000000000003002","article-title":"The Utility of ICU Readmission as a Quality Indicator and the Effect of Selection","volume":"46","author":"Maharaj","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Czajka, S., Zi\u0119bi\u0144ska, K., Marczenko, K., Posmyk, B., Szczepa\u0144ska, A.J., and Krzych, \u0141.J. (2020). Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: A cohort study. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-020-01203-7"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Stoian, M., Andone, A., B\u00e2ndil\u0103, S.R., Oni\u0219or, D., Laszlo, S.\u0218., Lupu, G., Danielescu, A., Baba, D.-F., V\u0103sie\u0219iu, A.M., and Manea, A. (2025). Mechanical Ventilator-Associated Pneumonia in the COVID-19 Pandemic Era: A Critical Challenge in the Intensive Care Units. Antibiotics, 14.","DOI":"10.3390\/antibiotics14010028"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Stoian, M., Azamfirei, L., Andone, A., V\u0103sie\u0219iu, A.-M., St\u00eengaciu, A., Hu\u021banu, A., B\u00e2ndil\u0103, S.R., Dobru, D., Manea, A., and Stoian, A. (2025). Incidence and Risk Factors of Secondary Infections in Critically III SARS-CoV-2 Patients: A Retrospective Study in an Intensive Care Unit. Biomedicines, 13.","DOI":"10.3390\/biomedicines13061333"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1097\/CCM.0000000000001856","article-title":"ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research","volume":"44","author":"Nates","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hiller, M., Burisch, C., Wittmann, M., Bracht, H., Kaltwasser, A., and Bakker, J. (2024). The current state of intensive care unit discharge practices-Results of an international survey study. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1377902"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4266\/acc.2020.00626","article-title":"Challenges of the patient transition process from the intensive care unit: A qualitative study","volume":"36","author":"Ghorbanzadeh","year":"2021","journal-title":"Acute Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/CCM.0b013e3182a272c0","article-title":"Critical Care Transition Programs and the Risk of Readmission or Death After Discharge From an ICU: A Systematic Review and Meta-Analysis","volume":"42","author":"Niven","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1111\/aas.13591","article-title":"Critical care transition programs on readmission or death: A systematic review and meta-analysis","volume":"64","author":"Gerhardsson","year":"2020","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s00134-015-4173-7","article-title":"Critical care transition programs and the risk of readmission or death after discharge from ICU","volume":"42","author":"Stelfox","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ruppert, M.M., Loftus, T.J., Small, C.B., Li, H.B., Ozrazgat-Baslanti, T., Balch, J., Holmes, R.B., Tighe, P.J., Upchurch, G.R.J.M., and Efron, P.A.M. (2023). Predictive Modeling for Readmission to Intensive Care: A Systematic Review. Crit. Care Explor., 5.","DOI":"10.1097\/CCE.0000000000000848"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103378","DOI":"10.1016\/j.iccn.2022.103378","article-title":"The risk assessment tool for intensive care unit readmission: A systematic review and meta-analysis","volume":"76","author":"Long","year":"2023","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1177\/0885066620949164","article-title":"A Tool to Predict Readmission to the Intensive Care Unit in Surgical Critical Care Patients\u2014The RISC Score","volume":"36","author":"Hammer","year":"2021","journal-title":"J. Intensive Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Mcneill, H., and Khairat, S. (2020). Impact of Intensive Care Unit Readmissions on Patient Outcomes and the Evaluation of the National Early Warning Score to Prevent Readmissions: Literature Review. JMIR Perioper. Med., 3.","DOI":"10.2196\/13782"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Amagai, S., Chaudhari, V., Chhikara, K., Ingraham, N.E., Hochberg, C.H., Barker, A.K., Mao, C., Ortiz, A.C., Weissman, G.E., and Schmid, B.E. (2025). The Epidemiology of Intensive Care Unit Readmissions Across Ten Health Systems. medRxiv, medRxiv: 2025.03.10.25323672.","DOI":"10.1101\/2025.03.10.25323672"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Cumberworth, J., Chequers, M., Bremner, S., Boyd, O., and Philips, B. (2022). Mortality and readmission rates of patients discharged in-hours and out-of-hours from a British ICU over a 3-year period. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-10613-1"},{"key":"ref_29","first-page":"58","article-title":"Risk factors for readmission to ICU and analysis of intra-hospital mortality","volume":"158","year":"2022","journal-title":"Med. Cl\u00ednica (Engl. Ed.)"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s43168-025-00402-5","article-title":"Risk factors and associated outcomes of respiratory ICU readmission","volume":"19","author":"Hasswa","year":"2025","journal-title":"Egypt. J. Bronchol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/CCM.0000000000004024","article-title":"Early and Late Mortality Following Discharge From the ICU: A Multicenter Prospective Cohort Study","volume":"48","author":"Rosa","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Fuchs, P.A., Czech, I.J., and Krzych, \u0141.J. (2019). The Pros and Cons of the Prediction Game: The Never-ending Debate of Mortality in the Intensive Care Unit. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16183394"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/10\/479\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T08:10:20Z","timestamp":1759479020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/10\/479"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jpm15100479"],"URL":"https:\/\/doi.org\/10.3390\/jpm15100479","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]}}}