Related Experiment Video
Updated: Oct 10, 2025
Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
Characteristics and Outcomes for Low-Risk Hospital Admissions Admitted to the ICU: A Multisite Cohort Study
Ross T Prager1, Michael T Pratte2, Laura H Thompson3
1Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Insights
Low-risk patients admitted to the intensive care unit (ICU) still face significant mortality risks. Key factors influencing outcomes include age, organ dysfunction, and hospital-acquired infections.
Area of Science:
- Critical Care Medicine
- Health Services Research
Background:
- Prognostication in the intensive care unit (ICU) typically relies on established risk factors.
- Outcomes for patients admitted to the ICU despite being classified as low-risk upon hospital admission are less understood.
Purpose of the Study:
- To characterize patients admitted to the ICU with a low-risk profile at hospital admission.
- To determine the outcomes and associated costs for this low-risk ICU patient group.
Main Methods:
- A historical cohort study utilized a prospectively maintained ICU registry from The Ottawa Hospital (2011-2016).
- Patients were categorized as low-risk using the Hospital-patient 1-year Mortality Risk at admission score.
- Inhospital mortality was the primary outcome, with secondary outcomes including adverse events and resource utilization.
Main Results:
- Of 17,173 ICU patients, 20.1% were low-risk, characterized by younger age and lower Multiple Organ Dysfunction Score (MODS).
- Low-risk patients had significantly lower inhospital mortality (4.1%) compared to non-low-risk patients (25.4%).
- Independent predictors of mortality in low-risk patients included older age, higher MODS, fluid management adverse events, hospital-acquired infections, and mechanical ventilation.
Conclusions:
- Low-risk ICU patients experience significant inhospital mortality despite their initial favorable prognosis.
- Adverse events related to fluid management, hospital-associated infections, multiple organ dysfunction, and mechanical ventilation are critical prognostic factors for this population.
Importance:
Prognostication following ICU admission can often be determined based on known risk factors, including demographics and illness severity; however, little is known about outcomes of patients deemed to be "low-risk" at the time of hospital admission who subsequently are admitted to the ICU.
Objectives:
The objectives of this study were to determine the characteristics, outcomes, and costs for patients requiring ICU admission despite having lower predicted mortality when they were admitted to the hospital.
Design Setting And Participants:
In this historical cohort study, we used a prospectively maintained ICU registry that included all ICU admissions to The Ottawa Hospital for patients 18 years or older from January 2011 to December 2016. We classified patients as low-risk using the Hospital-patient 1-year Mortality Risk at admission score, a hospital admission score validated to predict 1-year mortality.
Main Outcomes And Measures:
The primary outcome was inhospital mortality. Secondary outcomes included adverse events, resource utilization, and costs.
Results:
Of the 17,173 total ICU patients, 3,445 (20.1%) were classified as low-risk at hospital admission. Low-risk patients were younger (48.7 vs 67.5 yr; p < 0.001) and had a lower Multiple Organ Dysfunction Score (2.37 vs 4.14; p < 0.001). Mortality for low-risk patients was significantly lower than for non-low-risk patients (4.1% vs 25.4%; p < 0.001). For low-risk patients, multivariable logistic regression showed mortality was independently associated with older age (odds ratio, 1.02 per 1 yr; 95% CI, 1.00-1.03 per 1 yr), Multiple Organ Dysfunction Score (odds ratio, 1.42 per 1 point; 95% CI, 1.31-1.54 per 1 point), fluid management adverse events (odds ratio, 2.84; 95% CI, 1.29-6.25), hospital-acquired infections (odds ratio, 1.60; 95% CI, 1.02-2.51), and mechanical ventilation (odds ratio, 1.98; 95% CI, 1.20-3.26).
Conclusions And Relevance:
Despite their robust premorbid status, low-risk patients admitted to the ICU had significant inhospital mortality. Fluid management adverse events, hospital-associated infections, multiple organ dysfunction, and mechanical ventilation are important prognostic factors for low-risk patients.
More Related Videos
05:16Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
06:52Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Related Concept Videos
00:59Hospitals-II
Nurses that work in...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:30Acute Coronary Syndrome III: Diagnostic Studies