Keenan SP, Dodek P, Chan K, et al. Intensive care unit admission has minimal impact on long-term mortality

Royal Columbian Hospital, نيو ويستمينيستر، كولومبيا البريطانية, British Columbia, Canada
Critical Care Medicine (Impact Factor: 6.31). 04/2002; 30(3):501-7. DOI: 10.1097/00003246-200203000-00002
Source: PubMed


To measure the association between intensive care unit (ICU) admission and both hospital and long-term mortality, separate from the effect of hospital admission alone.
Retrospective cohort study.
All hospitals in British Columbia, Canada, during 3 fiscal years, 1994 to 1996.
A total of 27,103 patients admitted to ICU and 41,308 (5% random sample) patients admitted to hospital but not to ICU.
Although ICU admission was an important factor associated with hospital mortality (odds ratio: 9.12; 95% confidence interval: 8.34-9.96), the association between ICU admission and mortality after discharge was relatively minimal (hazard ratio: 1.21; 95% confidence interval: 1.17-1.27) and was completely overshadowed by the effect of age, gender, and diagnosis.
After controlling for the effect of hospital admission, admission to ICU has minimal independent effect on mortality after discharge.

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    • "Data from cohort studies examining mortality after critical illness are mixed with regard to whether or not there is a residual long-term risk of death [2-4]. But taken together with other studies, primarily of subgroups of patients such as those with the acute respiratory distress syndrome [5,6], and severe sepsis [7], the data of Cuthbertson and colleagues provide a consistent picture of the risk of morbidity, demonstrating that many ICU survivors continue to struggle with decreased quality of life. "
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    ABSTRACT: Data continue to emerge demonstrating the poor quality of life of ICU survivors in the months and years following critical illness. In this issue of Critical Care, Cuthbertson and colleagues present new data on quality of life from a cohort of ICU survivors who were followed for 5 years. They found that survivors had poor physical quality of life and low quality adjusted life-years in comparison to age-adjusted norms, describing the long-term impact of critical illness as similar to a co-morbidity. Studies are now needed that seek to identify potentially modifiable factors both during and following an ICU admission to allow for eventual improvement in long-term morbidity. Such studies will likely need to incorporate extensive planning for data collection, as well as coordinated linkage with other available datasets that include substantial amounts of patient information from outside of the ICU.
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    • "Similar results were previously reported for ARDS patients [8]. According to our risk model, known factors such as severity of illness, presence of chronic underlying disease, and admission category were risk factors for long-term mortality even in our series [28-30]. Although hospital-acquired pneumonia on admission to the ICU was not a risk factor for hospital mortality, it was a significant risk factor for long-term mortality among the patients surviving hospital discharge. "
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    ABSTRACT: The aim of this study was to evaluate the impact of intensive care unit (ICU)-acquired infection on long-term survival and quality of life. Long-term survival was prospectively evaluated among hospital survivors who had stayed in a mixed, university-level ICU for longer than 48 hours during a 14-month study period during 2002 to 2003. Health-related quality of life was assessed using the five-dimensional EuroQol (EQ-5D) questionnaire in January 2005. Of the 272 hospital survivors, 83 (30.5%) died after discharge during the follow-up period. The median follow-up time after hospital discharge was 22 months. Among patients without infection on admission, long-term mortality did not differ between patients who developed and those who did not develop an ICU-acquired infection (21.7% versus 26.9%; P = 0.41). Also, among patients with infection on admission, there was no difference in long-term mortality between patients who developed a superimposed (35.1%) and those who did not develop a superimposed (27.6%) ICU-acquired infection (P = 0.40). The EQ-5D response rate was 75 %. The patients who developed an ICU-acquired infection had significantly more problems with self-care (50%) than did those without an ICU-acquired infection (32%; P = 0.004), whereas multivariate analysis did not show ICU-acquired infection to be a significant risk factor for diminished self-care (odds ratio = 1.71, 95% confidence interval = 0.65-4.54; P = 0.28). General health status did not differ between those with and those without an ICU-acquired infection, as measured using the EuroQol visual-analogue scale (mean +/- standard deviation EuroQol visual-analogue scale value: 60.2 +/- 21 in patients without ICU-acquired infection versus 60.6 +/- 22 in those with ICU-acquired infection). The current general level of health compared with status before ICU admission did not differ between the groups either. Only 36% of those employed resumed their previous jobs. ICU-acquired infection had no impact on long-term survival. The patients with ICU-acquired infection more frequently experienced problems with self-care than did those without ICU infection, but ICU-acquired infection was not a significant risk factor for diminished self-care in multivariate analysis.
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