{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:19:10Z","timestamp":1792790350863,"version":"4.5.0"},"posted":{"date-parts":[[2026,9,14]]},"group-title":"Intensive Care and Critical Care Medicine","reference-count":18,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"name":"National Center for Advancing Translational Sciences","award":["UL1TR002541"],"award-info":[{"award-number":["UL1TR002541"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>General ICU severity scores predict hospital mortality across heterogeneous populations, not recovery within one diagnosis. We described favourable discharge across the range of APACHE IVa-predicted hospital mortality after cardiac arrest, and tested whether any bedside subgroup fell below a pre-specified benchmark.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Observational cohort of 3,641 first ICU admissions in 161 eICU hospitals with a cardiac-arrest diagnosis documented within 24 hours. The exposure was APACHE IVa-predicted hospital mortality; the outcome was favourable discharge (home or rehabilitation), a functional-outcome proxy. Fourteen bedside subgroups were pre-specified; the benchmark required an upper 95% bound below 5%.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Favourable discharge occurred in 1,039 (28.5%), falling from 78.9% in the lowest predicted-mortality decile to 4.1% in the highest (trend z, -27.2; P &lt; 0.001). Among 2,139 patients with predicted mortality at or above 50%, 301 (14.1%; 95% CI, 12.6 to 15.6) had a favourable discharge; among 281 at or above 90%, 9 (3.2%) did. No subgroup had an upper 95% bound below 5%; the lowest was 8 of 264 (3.0%; 95% CI, 1.3 to 5.9). At a more permissive 10% benchmark, two qualified. Among 1,961 not obeying commands, 263 (13.4%) had a favourable discharge. Discrimination did not differ detectably between unfavourable functional outcome (AUROC 0.789) and in-hospital death (0.774; P = 0.078).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Favourable discharge declined as predicted mortality rose but remained observable at the highest risk levels, and no pre-specified subgroup was bounded below 5%. A general ICU mortality estimate is not on its own evidence that a favourable outcome is absent.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.13.26362943","type":"posted-content","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:35:13Z","timestamp":1789446913000},"source":"Crossref","is-referenced-by-count":0,"title":["Favourable discharge after cardiac arrest across APACHE IVa-predicted hospital mortality: a multicentre observational study"],"prefix":"10.64898","author":[{"given":"Alon","family":"Gorenshtein","sequence":"first","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"},{"name":"BRIDGE GenAI Lab, Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Srour","sequence":"additional","affiliation":[{"name":"BRIDGE GenAI Lab, Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosef","family":"Adiniaev","sequence":"additional","affiliation":[{"name":"BRIDGE GenAI Lab, Beth Israel Deaconess Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiftach","family":"Barash","sequence":"additional","affiliation":[{"name":"BRIDGE GenAI Lab, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyal","family":"Klang","sequence":"additional","affiliation":[{"name":"BRIDGE GenAI Lab, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oved","family":"Daniel","sequence":"additional","affiliation":[{"name":"Neurology Division, Tel Aviv Sourasky University Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026091711151688000_2026.09.13.26362943v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000215112.84523.F0"},{"key":"2026091711151688000_2026.09.13.26362943v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2025.110809"},{"key":"2026091711151688000_2026.09.13.26362943v1.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06198-w"},{"key":"2026091711151688000_2026.09.13.26362943v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2022.03.008"},{"key":"2026091711151688000_2026.09.13.26362943v1.5","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1595814"},{"key":"2026091711151688000_2026.09.13.26362943v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2012.10.024"},{"key":"2026091711151688000_2026.09.13.26362943v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2018.10.022"},{"key":"2026091711151688000_2026.09.13.26362943v1.8","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-017-0392-y"},{"key":"2026091711151688000_2026.09.13.26362943v1.9","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005025"},{"key":"2026091711151688000_2026.09.13.26362943v1.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"2026091711151688000_2026.09.13.26362943v1.11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"2026091711151688000_2026.09.13.26362943v1.12","doi-asserted-by":"publisher","DOI":"10.1038\/sdata.2018.178"},{"key":"2026091711151688000_2026.09.13.26362943v1.13","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-022-01899-x"},{"key":"2026091711151688000_2026.09.13.26362943v1.14","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006074"},{"key":"2026091711151688000_2026.09.13.26362943v1.15","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.23.e215"},{"key":"2026091711151688000_2026.09.13.26362943v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2011.03.034"},{"key":"2026091711151688000_2026.09.13.26362943v1.17","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/26.4.404"},{"key":"2026091711151688000_2026.09.13.26362943v1.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1995.tb02031.x"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.09.13.26362943","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:15:24Z","timestamp":1789668924000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.09.13.26362943"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":18,"URL":"https:\/\/doi.org\/10.64898\/2026.09.13.26362943","relation":{},"subject":[],"published":{"date-parts":[[2026,9,14]]},"subtype":"preprint"}}