P. LEI, Y. XU, Y. ZHANG
Objective: Four dynamic clinical states were identified in the first 72 h of stroke intensive care in one centre. We tested whether this representation transports to an independent multicentre cohort, predicts the next state, and is independently recovered. Materials and Methods: 8279 adults in 176 hospitals (eICU CRD v2.0) contributed 70 630 six hour windows. Phenotype, dictionaries and eligibility rules were frozen before any state was assigned; the model was applied unchanged and judged against five prespecified criteria. Generalised estimating equations related state to subsequent organ support and ICU death; prediction was assessed against a persistence null at 6, 12 and 24 h; a model was fitted de novo in the strictest scope. Results: All five transportability criteria were met in all four scopes. All nine state outcome comparisons reproduced the direction of association, with exact rank order for invasive ventilation and ICU death; between hospital intraclass correlations were 0.012 to 0.027. States persisted across 90.7% of pairs, so prediction was scored on change: AUROC (95% CI) 0.730 (0.723 to 0.736) externally, 0.735 (0.721to 0.749) internally. Fitted de novo, eICU favoured four by BIC but three by restart reproducibility; neither recovered neurological impairment low support, the other three matched closely in both (r = 0.962 to 0.991). Discussion: The representation transports and carries forward-looking information but is not fully rediscoverable. The unrecovered state is defined by a combination, not a feature: eICU places its windows consistently but never pairs impairment with absent organ support. Conclusion: Three of four states are strongly supported. Transportability and independent rediscovery are distinct and should be reported separately.