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Determinants of postintensive care unit mortality: A prospective multicenter study
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Determinants of postintensive care unit mortality: A prospective multicenter study
作者:
Elie,
Azoulay Christophe,
Adrie Arnaud,
De Lassence Frederic,
Pochard Delphine,
Moreau Guillaume,
Thiery Christine,
Cheval Pierre,
Moine Maïté,
Garrouste-Orgeas Corinne,
Alberti Yves,
Cohen Jean-François,
期刊:
Critical Care Medicine
(OVID Available online 2003)
卷期:
Volume 31,
issue 2
页码: 428-432
ISSN:0090-3493
年代: 2003
出版商: OVID
关键词: mortality;intensive care unit;multicenter;do-not-resuscitate orders;severity;France;discharge;triage
数据来源: OVID
摘要:
ObjectiveSix to 25 percent of patients discharged alive from the intensive care unit (ICU) die before hospital discharge. Although this post-ICU mortality may indicate premature discharge from a full ICU or suboptimal management in the ICU or ward, another factor may be discharge from the ICU as part of a decision to limit treatment of hopelessly ill patients. We investigated determinants of post-ICU mortality, with special attention to this factor.DesignProspective, multicenter, database study.SettingSeven ICUs in or near Paris, France.PatientsA total of 1,385 patients who were discharged alive from an ICU after a stay of ≥48 hrs; 150 (10.8%) died before hospital discharge. Decisions to withhold or withdraw life-sustaining treatments were implemented in the ICUs in 80 patients, including 47 (58.7%) who died before hospital discharge.InterventionsNone.Measurements and Main ResultsIn the univariate analysis, post-ICU mortality was associated with advanced age, poor chronic health status, severe comorbidities, severity and organ failure scores (Simplified Acute Physiology Score II, sepsis-related organ failure assessment, and Logistic Organ Dysfunction at admission and at ICU discharge), decisions to withhold or withdraw life-sustaining treatments, and Omega score (reflecting ICU resource utilization and length of ICU stay). Multivariate stepwise logistic regression identified five independent determinants of post-ICU mortality: McCabe class 1 (odds ratio, 0.388 [95% confidence interval, 0.26–0.58]), transfer from a ward (odds ratio, 1.89 [95% confidence interval, 1.27–2.80]), Simplified Acute Physiology Score II score at admission >36 (odds ratio, 1.57 [95% confidence interval, 1.6–2.33]), decisions to withhold or withdraw life-sustaining treatments (odds ratio, 9.64 [95% confidence interval, 5.75–16.6]), and worse sepsis-related organ failure assessment score at discharge (odds ratio, 1.11 [95% confidence interval, 1.03–1.18] per point).ConclusionsMore than 10% of ICU survivors died before hospital discharge. Determinants of post-ICU mortality included variables reflecting patient status before and during the ICU stay. However, the most powerful predictor of post-ICU mortality was the decision to withhold or withdraw life-sustaining treatments in the ICU, suggesting that the decision has been made not to use the unique services of the ICU for these patients.
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