Persistent Critical Illness Among Intensive Care Patients in India: A Registry-Embedded Cohort Study.

Area of Science:

• Critical care medicine
• Epidemiology
• Health outcomes research

Background:

• Persistent critical illness (PCI) is defined by the diminished predictive power of acute illness characteristics compared to antecedent factors in high-income countries.
• This phenomenon has not been well-characterized in low- and middle-income countries, such as India.

Purpose of the Study:

• To evaluate the occurrence and characteristics of persistent critical illness in critically ill patients admitted to intensive care units (ICUs) in India.
• To compare the prognostic performance of acute versus antecedent patient characteristics over time in an Indian ICU cohort.

Main Methods:

• A cohort study was conducted across 56 ICUs in India, part of the Indian Registry of Intensive Care.
• Adult critically ill patients were included, with analyses focusing on hospital mortality.
• Generalized mixed-effects models were used to assess the association of acute and antecedent characteristics with outcomes, including post hoc comparisons of patients with ICU stays longer than 7 days.

Main Results:

• The study included 42,925 patients with a hospital mortality rate of 17.4%.
• The prognostic performance of acute illness characteristics (admission diagnosis, acute physiology) declined significantly over time (AUROC from 0.76 to 0.69), while antecedent characteristics (age, comorbidities) remained poor predictors (AUROC ~0.56).
• Patients with ICU stays exceeding 7 days (33.1% hospital mortality) were sicker, received more organ support (ventilation, vasopressors, kidney replacement therapy), and had significantly higher mortality compared to those with shorter stays.

Conclusions:

• In Indian ICUs, the prognostic value of acute illness factors diminishes with prolonged ICU stay, while baseline patient characteristics are consistently poor predictors.
• The established definition of persistent critical illness from high-income countries was not observed in this Indian cohort.
• Patients with longer ICU stays experienced worse outcomes and required more intensive interventions, highlighting the need for context-specific understanding of critical illness trajectories.