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Determinants of postintensive care unit mortality: a prospective multicenter study.
Elie Azoulay1, Christophe Adrie, Arnaud De Lassence
1Medical ICU, Hôpital Saint Louis, Paris, France.
Critical Care Medicine
|February 11, 2003
Summary
Over 10% of intensive care unit (ICU) survivors die before hospital discharge. Decisions to withdraw life-sustaining treatments in the ICU were the strongest predictor of this post-ICU mortality.
Area of Science:
- Critical Care Medicine
- Hospital Medicine
- Patient Outcomes Research
Background:
- Post-intensive care unit (ICU) mortality affects 6-25% of patients discharged alive from the ICU.
- This mortality may stem from premature discharge, suboptimal care, or decisions to limit treatment for critically ill patients.
Purpose of the Study:
- To investigate the determinants of post-ICU mortality.
- To specifically examine the impact of decisions to withhold or withdraw life-sustaining treatments on post-ICU mortality.
Main Methods:
- Prospective, multicenter database study conducted in seven ICUs in France.
- Included 1,385 patients discharged alive from ICU after >= 48 hours stay.
- Analyzed factors associated with death before hospital discharge.
Main Results:
- 10.8% of patients (150/1385) died before hospital discharge.
- Multivariate analysis identified key predictors: McCabe class 1, ward transfer, high Simplified Acute Physiology Score II on admission, and sepsis-related organ failure assessment score at discharge.
- Decisions to withhold or withdraw life-sustaining treatments in the ICU were the most powerful predictor (OR 9.64).
Conclusions:
- Post-ICU mortality is a significant issue, with over 10% of survivors dying before hospital discharge.
- Patient status before and during ICU stay influences mortality.
- The decision to withhold or withdraw life-sustaining treatments is the strongest predictor, indicating these patients may not benefit from continued ICU care.