A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation

Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Critical care medicine (Impact Factor: 6.31). 07/2008; 36(7):2061-9. DOI: 10.1097/CCM.0b013e31817b8925
Source: PubMed


A measure that identifies patients who are at high risk of mortality after prolonged ventilation will help physicians communicate prognoses to patients or surrogate decision makers. Our objective was to develop and validate a prognostic model for 1-yr mortality in patients ventilated for 21 days or more.
The authors conducted a prospective cohort study.
The study took place at a university-based tertiary care hospital.
Three hundred consecutive medical, surgical, and trauma patients requiring mechanical ventilation for at least 21 days were prospectively enrolled.
Predictive variables were measured on day 21 of ventilation for the first 200 patients and entered into logistic regression models with 1-yr and 3-mo mortality as outcomes. Final models were validated using data from 100 subsequent patients. One-year mortality was 51% in the development set and 58% in the validation set. Independent predictors of mortality included requirement for vasopressors, hemodialysis, platelet count < or = 150 x 10(9)/L, and age > or = 50 yrs. Areas under the receiver operating characteristic curve for the development model and validation model were .82 (SE .03) and .82 (SE .05), respectively. The model had sensitivity of .42 (SE .12) and specificity of .99 (SE .01) for identifying patients who had > or = 90% risk of death at 1 yr. Observed mortality was highly consistent with both 3- and 12-mo predicted mortality. These four predictive variables can be used in a simple prognostic score that clearly identifies low-risk patients (no risk factors, 15% mortality) and high-risk patients (three or four risk factors, 97% mortality).
Simple clinical variables measured on day 21 of mechanical ventilation can identify patients at highest and lowest risk of death from prolonged ventilation.

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    • "Several studies reported that these patients consumed a disproportionately high amount of healthcare resources and medical expenses both in the intensive care unit (ICU) and after hospital discharge1-10. There were also several reports regarding prognostic factors for these patients to help physicians determine prognoses by communicating with patients or their surrogates3,11,12. "
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    ABSTRACT: We evaluated the clinical outcomes and prognostic factors of patients requiring prolonged mechanical ventilation (PMV), defined as ventilator care for ≥21 days, who were admitted to the medical intensive care unit (ICU) of a university hospital in Korea. During the study period, a total of 2,644 patients were admitted to the medical ICU, and 136 patients (5.1%) were enrolled between 2005 and 2010. The mean age of the patients was 61.3±14.5 years, and 94 (69.1%) were male. The ICU and six-month cumulative mortality rates were 45.6 and 58.8%, respectively. There were 96 patients with tracheostomy placement after admission and their mean period from admission to the day of tracheostomy was 21.3±8.4 days. Sixty-three patients (46.3%) were successfully weaned from ventilator care. Of the ICU survivors (n=74), 34 patients (45.9%) were transferred to other hospitals (not university hospitals). Two variables (thrombocytopenia [hazard ratio (HR), 1.964; 95% confidence interval (CI), 1.225~3.148; p=0.005] and the requirement for vasopressors [HR, 1.822; 95% CI, 1.111~2.986; p=0.017] on day 21) were found to be independent factors of survival on based on the Cox proportional hazard model. We found that patients requiring PMV had high six-month cumulative mortality rates, and that two clinical variables (measured on day 21), thrombocytopenia and requirement for vasopressors, may be associated with prognostic indicators.
    10/2012; 73(4):224-30. DOI:10.4046/trd.2012.73.4.224
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    • "Our study found 3-month and 1-year survival rates (51.4% and 31.9%, respectively) similar to those observed in a U.S. university-based tertiary-care hospital [30], suggesting that patients with PMV have poor survival even in societies with high levels of providing MV care. Persistent poor functional status after a PMV incidence was observed among most patients in a U.S. study that was based on 5 intensive care units [13]. "
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    BMC Health Services Research 04/2012; 12(1):100. DOI:10.1186/1472-6963-12-100 · 1.71 Impact Factor
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    • "This is most likely due to a smaller sample size (VAD, n = 23, and cardiogenic shock, n = 33). Nevertheless, our findings of decreased survival with VAD and cardiogenic shock are supported by other studies showing that prolonged hemodynamic compromise, cardiac dysfunction, and vasopressor requirements are associated with increased mortality in the cardiac surgery and general ICU populations [2] [12] [23] [24] [25] [26]. Our findings likely represent the significant short-term mortality of terminal and irreversible disease processes similar to those with profound cardiac dysfunction. "
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