Selecting patients for ICU up-grade from general wards: role of prognostic tools

The decision to admit patients to the intensive care unit (ICU) can be difficult, especially when it is unclear which patients will benefit the most. Therefore, identifying the determinants of complications can aid in patient therapy. The aim of this study was to evaluate the characteristics of patients who were admitted late to the ICU and identify the main factors that contribute to their admission. This case‒control study was conducted in a tertiary hospital and included 4 years of follow-up (using medical records). The study included patients who were at risk for deterioration and admitted to clinical wards. The main measure, whether ICU admission was needed or not, was compared among the patients. We included 170 patients aged 60.6 ± 13.6 years. The multivariate analysis revealed that the qSOFA and CCI values were independent factors in determining whether a patient required ICU admission (OR = 8.25, CI 95% = 4.4-15.3 and OR = 1.37, CI 95% = 1.03-1.82, respectively); the ROC value was 0.89 (95% CI 0.83-0.93). The Cox regression model used to assess 90-day survival revealed that only the qSOFA value was strongly associated with shorter survival (qSOFA = 1, HR = 9.42, P = 0.03; qSOFA = 2, HR = 17.7, P = 0.005; and qSOFA = 3, HR = 73.7, P < 0.001). Although selecting high-risk patients for ICU admission is a difficult task, the qSOFA score appears to be a useful tool for differentiating patients.