Critically ill patients with high predicted mortality: Incidence and outcome.
Med Intensiva 2024;
48:85-91. [PMID:
37985339 DOI:
10.1016/j.medine.2023.11.001]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/16/2023] [Accepted: 10/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE
As calculated by the severity scores, an unknown number of patients are admitted to the Intensive Care Unit (ICU) with a very high risk of death. Clinical studies have poorly addressed this population, and their prognosis is largely unknown.
DESIGN
Post hoc analysis of a multicenter, cohort, longitudinal, observational, retrospective study (CIMbA).
SETTING
Sixteen Portuguese multipurpose ICUs.
PATIENTS
Patients with a Simplified Acute Physiology Score II (SAPS II) predicted hospital mortality above 80% on admission to the ICU (high-risk group); A comparison with the remaining patients was obtained.
INTERVENTIONS
None.
MAIN VARIABLES OF INTEREST
Hospital, 30 days, 1 year mortality.
RESULTS
We identified 4546 patients (59.9% male), 12.2% of the whole population. Their SAPS II predicted hospital mortality was 89.0±5.8%, whilst the observed mortality was lower, 61.0%. This group had higher mortality, both during the first 30 days (aHR 3.52 [95% CI 3.34-3.71]) and from day 31 to day 365 after ICU admission (aHR 1.14 [95%CI 1.04-1.26]), respectively. However, their hospital standardized mortality ratio was similar to the other patients (0.69 vs. 0.69, P=.92). At one year of follow-up, 30% of patients in the high-risk group were alive.
CONCLUSIONS
Roughly 12% of patients admitted to the ICU for more than 24h had a SAPS II score predicted mortality above 80%. Their hospital standardized mortality was similar to the less severe population and 30% were alive after one year of follow-up.
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