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Increased need for interventions predicts mortality in the critically ill.
I Efendijev1, R Raj2, M B Skrifvars3,4
1Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. ilmar.efendijev@helsinki.fi.
Acta Anaesthesiologica Scandinavica
|September 24, 2016
Summary
An early increase in treatment intensity, measured by the Therapeutic Intervention Scoring System (TISS), was linked to higher hospital mortality in intensive care unit (ICU) patients. This finding was particularly notable in patients with initially lower illness severity.
Area of Science:
- Critical Care Medicine
- Health Services Research
Background:
- Assessing treatment intensity is crucial for understanding patient outcomes in intensive care units (ICUs).
- Early changes in treatment intensity may predict hospital mortality.
Purpose of the Study:
- To investigate the association between early changes in treatment intensity and hospital mortality among ICU patients.
- To evaluate the prognostic value of treatment intensity scores in predicting patient survival.
Main Methods:
- An observational study utilized a national ICU registry of adult patients in Finland (2003-2013) with ICU stays >3 days.
- Treatment intensity was measured using the Therapeutic Intervention Scoring System (TISS-76), focusing on the change between day 1 and day 3 (ΔTISS).
- Multivariate logistic regression and continuous net reclassification improvement (NRI) were employed to analyze the association and prognostic performance.
Main Results:
- Out of 42,493 patients, 29% showed an increase in TISS scores (ΔTISS > 0) and had a hospital mortality of 23%, compared to 18% mortality for ΔTISS ≤ 0.
- An early increase in TISS scores (ΔTISS > 0) was independently associated with significantly higher hospital mortality.
- Incorporating TISS data improved the prognostic model's performance, especially for patients with lower initial baseline risk.
Conclusions:
- An early rise in TISS scores signifies an increased risk of death in ICU patients.
- The prognostic impact of increased treatment intensity is more pronounced in patients with initially lower severity of illness.
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