Acquired organ system derangements and hospital mortality: are all organ systems created equally?

1999 ◽  
Vol 8 (3) ◽  
pp. 180-188 ◽  
Author(s):  
MH Kollef ◽  
G Sherman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Organ System ◽  
Neurological Dysfunction ◽  
Relative Importance ◽  
Surgical Intensive Care ◽  
Organ Systems

BACKGROUND: Acquired organ system derangements are common among patients who require intensive care, but the relative importance of different derangements as determinants of patients' outcomes is unclear. OBJECTIVES: To determine organ system derangements that occur in patients who require intensive care and the relative importance of different derangements to hospital mortality. METHODS: A prospective cohort study design was used to evaluate the occurrence of organ system derangements and hospital mortality in 617 adults admitted to the medical and surgical intensive care units of a university-affiliated teaching hospital. RESULTS: Eighty-three patients (13.5%) died while hospitalized. Patients who died had significantly more derangements than did patients who survived (3.3 +/- 1.2 vs 0.9 +/- 0.9; P < .001). The crude hospital mortality rate varied with the specific organ system involved (pulmonary, 23.6%; gastrointestinal, 25.0%; hepatic, 42.4%; hematological, 47.9%; cardiac, 54.0%; renal, 54.8%; neurological, 65.9%). Derangements of neurological function (adjusted odds ratio, 3.20; 95% CI, 2.0-5.3; P = .019) and cardiac function (adjusted odds ratio, 3.96; 95% CI, 2.63-5.99; P < .001) were independently associated with hospital mortality. Additionally, derangements occurred later during the stay in the intensive care unit in patients who died in the hospital than in patients who survived, especially for derangements of pulmonary, neurological, and renal function. CONCLUSION: Among critically ill patients, neurological and cardiac dysfunction are the acquired organ system derangements most closely associated with hospital mortality. These data suggest that hospital mortality depends on both the specific types of derangements that occur and the total number of such derangements. Interventions to prevent cardiac and neurological dysfunction have the greatest potential for improving outcomes for patients in the intensive care unit.

scholarly journals National trends in coronary intensive care unit admissions, resource utilization, and outcomes

2019 ◽  
Vol 9 (8) ◽  
pp. 923-930
Author(s):  
Sarah Woolridge ◽  
Wendimagegn Alemayehu ◽  
Padma Kaul ◽  
Christopher B Fordyce ◽  
Patrick R Lawler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mortality Rates ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Emerging evidence suggests that coronary intensive care units are evolving into intensive care environments with an increasing burden of non-cardiovascular illness, but previous studies have been limited to older populations or single center experiences. Methods: Canadian national health-care data was used to identify all patients ≥18 years admitted to dedicated coronary intensive care units (2005–2015) and admissions were categorized as primary cardiac or non-cardiac. The outcomes of interest included longitudinal trends in admission diagnoses, critical care therapies, and all-cause in-hospital mortality. Results: Among the 373,992 patients admitted to a coronary intensive care unit, minimal changes in the proportion of patients admitted with a primary cardiac (88.2% to 86.9%; p<0.001) and non-cardiac diagnoses (11.8% to 13.1%; p<0.001) were observed. Among cardiac admissions, a temporal increase in the proportion of ST-segment elevation myocardial infarction (19.4% to 24.1%, p<0.001), non-ST-segment elevation myocardial infarction (14.6% to 16.2%, p<0.001), heart failure (7.3% to 8.4%, p<0.001), shock (4.9% to 5.7%, p<0.001), and decline in unstable angina (4.9% to 4.0%, p<0.001) and stable coronary diseases (21.3% to 12.4%, p<0.001) was observed. The proportion of patients requiring critical care therapies (57.8% to 63.5%, p<0.001) including mechanical ventilation (9.6% to 13.1%, p<0.001) increased. In-hospital mortality rates for patients with primary cardiac (4.9% to 4.4%; adjusted odds ratio 0.71, 95% confidence interval 0.63–0.79) and non-cardiac (17.8% to 16.1%; adjusted odds ratio 0.84, 0.73–0.97) declined; results were consistent when stratified by academic vs community hospital, and by the presence of on-site percutaneous coronary intervention. Conclusion: In a national dataset we observed a changing case-mix among patients admitted to a coronary intensive care unit, though the proportion of patients with a primary cardiac diagnosis remained stable. There was an increase in clinical acuity highlighted by critical care therapies, but in-hospital mortality rates for both primary cardiac and non-cardiac conditions declined across all hospitals. Our findings confirm the changing coronary intensive care unit case-mix and have implications for future coronary intensive care unit training and staffing.

scholarly journals Defining Shock and Preshock for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Jacob C. Jentzer ◽  
Barry Burstein ◽  
Sean Van Diepen ◽  
Joseph Murphy ◽  
David R. Holmes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Cardiac Intensive Care Unit ◽  
Coronary Syndrome ◽  
Cardiac Intensive Care

Background: Previous studies have defined preshock as isolated hypotension or isolated hypoperfusion, whereas shock has been variably defined as hypoperfusion with or without hypotension. We aimed to evaluate the mortality risk associated with hypotension and hypoperfusion at the time of admission in a cardiac intensive care unit population. Methods: We analyzed Mayo Clinic cardiac intensive care unit patients admitted between 2007 and 2015. Hypotension was defined as systolic blood pressure <90 mm Hg or mean arterial pressure <60 mm Hg, and hypoperfusion as admission lactate >2 mmol/L, oliguria, or rising creatinine. Associations between hypotension and hypoperfusion with hospital mortality were estimated using multivariable logistic regression. Results: Among 10 004 patients with a median age of 69 years, 43.1% had acute coronary syndrome, and 46.1% had heart failure. Isolated hypotension was present in 16.7%, isolated hypoperfusion in 15.3%, and 8.7% had both hypotension and hypoperfusion. Stepwise increases in hospital mortality were observed with hypotension and hypoperfusion compared with neither hypotension nor hypoperfusion (3.3%; all P <0.001): isolated hypotension, 9.3% (adjusted odds ratio, 1.7 [95% CI, 1.4–2.2]); isolated hypoperfusion, 17.2% (adjusted odds ratio, 2.3 [95% CI, 1.9–3.0]); both hypotension and hypoperfusion, 33.8% (adjusted odds ratio, 2.8 [95% CI, 2.1–3.6]). Adjusted hospital mortality in patients with isolated hypoperfusion was higher than in patients with isolated hypotension ( P =0.02) and not significant different from patients with both hypotension and hypoperfusion ( P =0.18). Conclusions: Hypotension and hypoperfusion are both associated with increased mortality in cardiac intensive care unit patients. Hospital mortality is higher with isolated hypoperfusion or concomitant hypotension and hypoperfusion (classic shock). We contend that preshock should refer to isolated hypotension without hypoperfusion, while patients with hypoperfusion can be considered to have shock, irrespective of blood pressure.

Māori health outcomes in an intensive care unit in Aotearoa New Zealand

2021 ◽  
pp. 0310057X2198971
Author(s):  
M Atif Mohd Slim ◽  
Hamish M Lala ◽  
Nicholas Barnes ◽  
Robert A Martynoga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
One Year ◽  
Maori Health

Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

Lack of Association between Preoperative Statin Use and Respiratory and Neurologic Complications after Cardiac Surgery

2017 ◽  
Vol 126 (5) ◽  
pp. 799-809 ◽  
Author(s):  
Ryu Komatsu ◽  
Huseyin Oguz Yilmaz ◽  
Jing You ◽  
C. Allen Bashour ◽  
Shobana Rajan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Odds Ratio ◽  
Hospital Length Of Stay ◽  
Neurologic Complications ◽  
Prolonged Ventilation ◽  
Statin Use

Abstract Background Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. Methods The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions. Second, the authors analyzed the collapsed composite of neurologic complications using logistic regression. Intensive care unit and hospital length of stay were evaluated with Cox proportional hazard models. Results Among 14,129 eligible patients, 6,642 patients were successfully matched. There was no significant association between preoperative statin use and prolonged ventilation (statin: 408/3,321 [12.3%] vs. nonstatin: 389/3,321 [11.7%]), pneumonia (44/3,321 [1.3%] vs. 54/3,321 [1.6%]), and in-hospital mortality (52/3,321 [1.6%] vs. 43/3,321 [1.3%]). The estimated odds ratio was 1.06 (98.3% CI, 0.88 to 1.27) for prolonged ventilation, 0.81 (0.50 to 1.32) for pneumonia, and 1.21 (0.74 to 1.99) for in-hospital mortality. Neurologic outcomes were not associated with preoperative statin use (53/3,321 [1.6%] vs. 56/3,321 [1.7%]), with an odds ratio of 0.95 (0.60 to 1.50). The length of intensive care unit and hospital stay was also not associated with preoperative statin use, with a hazard ratio of 1.04 (0.98 to 1.10) for length of hospital stay and 1.00 (0.94 to 1.06) for length of intensive care unit stay. Conclusions Preoperative statin use did not reduce pulmonary or neurologic complications after cardiac surgery.

scholarly journals Timing of Admission to the Surgical Intensive Care Unit is Associated with in-Hospital Mortality

2021 ◽  
Author(s):  
Mi Kyoung Kim ◽  
Eun-Joo Jung ◽  
Seulkee Park ◽  
Im-kyung Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Outcome Measurement ◽  
Work Hours ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
After Hours ◽  
The Times ◽  
Unplanned Admissions

Abstract Background: Knowledge about the relationship between timing of admission to the intensive care unit (ICU) and mortality among surgical patients admitted for acute care is limited.Objective: We aimed to investigate whether admission to the surgical intensive care unit (SICU) during after-hours (all the times when intensivists were not staffed in the ICU) was associated with in-hospital mortality.Methods: This retrospective cohort study was conducted at a tertiary academic hospital, in which we analyzed data of 571 patients admitted to the SICU whose complete medical records were available. The work-hours were defined as 07:00-19:00 from Monday to Friday during which intensivists were staffed in the ICU. The after-hours were defined as all other times during which intensivists were not staffed in the SICU. The primary outcome measurement was in-hospital mortality according to the time of SICU admission.Results: In all, 333 and 238 patients were admitted to the SICU during work-hours and after-hours, respectively. Unplanned admissions (33.3% vs. 47.1%, p<0.001), Acute Physiology and Chronic Health Evaluation II score ≥25 (11.1% vs. 23.9%, p<0.001), ventilator support (17.4% vs. 34.0%, p<0.001), and use of inotropics (33.3% vs. 50.0%, p<0.001) were significantly higher in the after-hours group than in the work-hours group. In the multivariate analyses of the association between the time of SICU admission and in-hospital mortality, the timing of SICU admission was an independent factor for in-hospital mortality (OR=2.526; 95% CI=1.010-6.320, p=0.048). Conclusions: In this study, we found that admission to the SICU during after-hours was associated with increased in-hospital mortality.

scholarly journals Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

2018 ◽  
Vol 64 (9) ◽  
pp. 1361-1369 ◽  
Author(s):  
Pietro Caironi ◽  
Roberto Latini ◽  
Joachim Struck ◽  
Oliver Hartmann ◽  
Andreas Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P &lt; 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P &lt; 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine &gt;2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P &lt; 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

Unplanned Transfers From Intermediate Care Units to Intensive Care Units: A Cohort Study

2021 ◽  
Vol 30 (5) ◽  
pp. 397-400
Author(s):  
Joao Gabriel Rosa Ramos ◽  
Gabriel Machado Naus dos Santos ◽  
Marina Chetto Coutinho Bispo ◽  
Renata Cristina de Almeida Matos ◽  
Gil Mario Lopes Santos de Carvalho ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Observational Study ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Intermediate Care ◽  
Icu Mortality ◽  
Patient Transfers ◽  
Reason For Admission

This study evaluated unplanned transfers from the intermediate care unit (IMCU) to the intensive care unit (ICU) among urgent admissions. This retrospective, observational study was conducted in 2 ICUs and 1 IMCU. Three patterns of urgent admission were assessed: admissions to the ICU only, admissions to the IMCU only, and admissions to the IMCU with subsequent transfer to the ICU. Of 5296 admissions analyzed, 1396 patients (26.4%) were initially admitted to the IMCU. Of these, 172 (12.3%) were transferred from the IMCU to the ICU. Mortality was higher in patients transferred from the IMCU to the ICU than in the 3900 ICU-only patients (odds ratio, 3.22; 95% CI, 1.52-6.80). Most transfers from the IMCU to the ICU (135; 78.5%) were due to deterioration of the condition for which the patient was admitted. Patient transfers from the IMCU to the ICU were common, were associated with increased hospital mortality, and were mostly due to deterioration in the condition that was the reason for admission.

scholarly journals Invasive Blood Pressure Measurement and In-hospital Mortality in Critically Ill Patients With Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Bin Zhou ◽  
Liang-Ying Lin ◽  
Xiao-Ai Liu ◽  
Ye-Sheng Ling ◽  
Yuan-Yuan Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Invasive Blood Pressure

Background: Invasive blood pressure (IBP) measurement is common in the intensive care unit, although its association with in-hospital mortality in critically ill patients with hypertension is poorly understood.Methods and Results: A total of 11,732 critically ill patients with hypertension from the eICU-Collaborative Research Database (eICU-CRD) were enrolled. Patients were divided into 2 groups according to whether they received IBP. The primary outcome in this study was in-hospital mortality. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) models were used to balance the confounding covariates. Multivariable logistic regression was used to evaluate the association between IBP measurement and hospital mortality. The IBP group had a higher in-hospital mortality rate than the no IBP group in the primary cohort [238 (8.7%) vs. 581 (6.5%), p &lt; 0.001]. In the PSM cohort, the IBP group had a lower in-hospital mortality rate than the no IBP group [187 (8.0%) vs. 241 (10.3%), p = 0.006]. IBP measurement was associated with lower in-hospital mortality in the PSM cohort (odds ratio, 0.73, 95% confidence interval, 0.59–0.92) and in the IPTW cohort (odds ratio, 0.81, 95% confidence interval, 0.67–0.99). Sensitivity analyses showed similar results in the subgroups with high body mass index and no sepsis.Conclusions: In conclusion, IBP measurement was associated with lower in-hospital mortality in critically ill patients with hypertension, highlighting the importance of IBP measurement in the intensive care unit.

scholarly journals Transition From an Open to Closed Staffing Model in the Cardiac Intensive Care Unit Improves Clinical Outcomes

2021 ◽  
Author(s):  
P. Elliott Miller ◽  
Fouad Chouairi ◽  
Alexander Thomas ◽  
Yukiko Kunitomo ◽  
Faisal Aslam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Tertiary Care ◽  
Hospital Charges ◽  
Open Unit ◽  
Surgical Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Background Several studies have shown improved outcomes in closed compared with open medical and surgical intensive care units. However, very little is known about the ideal organizational structure in the modern cardiac intensive care unit (CICU). Methods and Results We retrospectively reviewed consecutive unique admissions (n=3996) to our tertiary care CICU from September 2013 to October 2017. The aim of our study was to assess for differences in clinical outcomes between an open compared with a closed CICU. We used multivariable logistic regression adjusting for demographics, comorbidities, and severity of illness. The primary outcome was in‐hospital mortality. We identified 2226 patients in the open unit and 1770 in the closed CICU. The unadjusted in‐hospital mortality in the open compared with closed unit was 9.6% and 8.9%, respectively ( P =0.42). After multivariable adjustment, admission to the closed unit was associated with a lower in‐hospital mortality (odds ratio [OR], 0.69; 95% CI: 0.53–0.90, P =0.007) and CICU mortality (OR, 0.70; 95% CI, 0.52–0.94, P =0.02). In subgroup analysis, admissions for cardiac arrest (OR, 0.42; 95% CI, 0.20–0.88, P =0.02) and respiratory insufficiency (OR, 0.43; 95% CI, 0.22–0.82, P =0.01) were also associated with a lower in‐hospital mortality in the closed unit. We did not find a difference in CICU length of stay or total hospital charges ( P >0.05). Conclusions We found an association between lower in‐hospital and CICU mortality after the transition to a closed CICU. These results may help guide the ongoing redesign in other tertiary care CICUs.

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