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Long-term mortality outcome associated with prolonged admission to the ICU
Kevin B Laupland1, Andrew W Kirkpatrick, John B Kortbeek
1Department of Critical Care Medicine, University of Calgary and Calgary Health Region, Calgary, AB, Canada. kevin.laupland@calgaryhealthregion.ca
Insights
Prolonged intensive care unit (ICU) admission is linked to higher mortality. However, patients surviving extended ICU stays show favorable long-term survival rates after their acute illness.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Epidemiology
Background:
- Prolonged intensive care unit (ICU) admissions strain healthcare resources and are associated with high in-hospital mortality.
- Long-term outcomes for patients with extended ICU stays are not well-defined in unselected populations.
Purpose of the Study:
- To determine the incidence and predictors of prolonged ICU admission.
- To evaluate the long-term mortality (>= 1 year) for patients requiring prolonged ICU stays.
Main Methods:
- A population-based cohort study was conducted in the Calgary Health Region.
- Data were collected from adult multisystem and cardiovascular surgical ICUs between July 1, 1999, and March 31, 2002.
- Included were adult residents admitted to regional ICUs.
Main Results:
- 4% of 4,845 patients experienced prolonged ICU admissions (>= 14 days).
- Higher illness severity, shock, and bloodstream infections predicted prolonged ICU stays; cardiovascular surgery was protective.
- Prolonged ICU admission (25%) was associated with nearly double the mortality compared to shorter stays (13%).
Conclusions:
- Approximately 1 in 25 critically ill patients require prolonged ICU care and face increased mortality.
- Survivors of prolonged ICU admissions demonstrate favorable long-term mortality outcomes post-discharge.
Study Objectives:
Patients requiring prolonged admission to the ICU consume significant health-care resources and have a high rate of in-hospital death. The long-term mortality outcome of these patients has not been well defined in a nonselected cohort. The objective of this study was to describe the occurrence and factors predictive of prolonged ICU stay at admission, and to define the long-term (>/= 1 year) mortality outcome.
Design:
Population-based cohort.
Setting:
All adult multisystem and cardiovascular surgical ICUs in the Calgary Health Region (CHR) from July 1, 1999, to March 31, 2002.
Patients:
Adult (>/= 18 years old) residents of the CHR admitted to regional ICUs.
Interventions:
None.
Measurements And Results:
During the study, 4,845 patients had a median length of stay of 2 days (interquartile range, 1 to 4 days); 2,115 patients (44%) were admitted for < 2 days, 1,496 patients (31%) were admitted for 2 to 3 days; 1,018 patients (21%) were admitted from 4 to 13 days; and 216 patients (4%) had a prolonged (>/= 14 day) admission to the ICU. A higher severity of illness, the presence of shock, and bloodstream infection were independently associated with a prolonged ICU admission, and cardiovascular surgery was associated with a lower risk. Patients with prolonged ICU admissions were nearly twice as likely to die as patients with shorter ICU admissions: 53 of 216 patients (25%) vs 584 of 4,629 patients (13%) [p = 0.0001]. Among the 3,924 survivors to hospital discharge, the rates of mortality during the year following ICU admission were as follows: 59 deaths in 1,758 patients (3%) admitted < 2 days, 74 deaths in 1,267 patients (6%) with 2- to 3-day admissions, 78 deaths in 766 patients (10%) with 4- to 13-day admissions, and 10 deaths in 133 patients (8%) with admissions >/= 14 days.
Conclusions:
One in 25 critically ill patients will have prolonged ICU admission and higher ICU-related mortality. However, survivors of prolonged ICU admission have good long-term mortality outcome after acute illness.
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