A Focus on SepsisSepsis and organ system failure are major determinants of post–intensive care unit mortality
Introduction
Mortality after discharge from the intensive care unit (ICU) remains a major concern in critically ill patients and has been reported to range from 6% to 31% [1], [2], [3], [4], [5], [6], [7], [8], [9]. Many prognostic factors for post-ICU mortality have been identified, including preadmission events [9], [10], [11], [12], severity of illness and comorbidities on admission to the ICU [7], [8], [9], and residual organ dysfunction/failure at ICU discharge [7], [8], [9]. A task force of the American College of Critical Care Medicine [13] has provided guidelines for ICU admission, discharge, and triage. However, this publication, provides relatively broad and nonspecific discharge criteria provided because of a lack of sufficient relevant data. Identifying the determinants of post-ICU death may, consequently, influence decision-making at ICU discharge, and hence may reduce mortality after ICU discharge by reducing inappropriate early discharge [14].
Factors related to therapy and evolution of the underlying disease process during the ICU stay may play an important role in determining post-ICU mortality. Sepsis syndromes are one such factor, not only because of their common occurrence in the ICU setting [15], [16], [17] but also because they are a major determinant of organ dysfunction/failure and of worse outcomes in critically ill patients [15], [17]. The aim of our study was, therefore, to investigate the predictors of post-ICU in-hospital mortality with special emphasis on the impact of sepsis syndromes and organ system failure.
Section snippets
Methods
This study is a subanalysis of the database from a prospective, multicenter, observational study, the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, which was designed to evaluate the epidemiology of sepsis among ICU patients in European countries. Recruitment, data collection, and management are detailed elsewhere [17]; briefly, all patients older than 15 years admitted to the 198 participating centers (see the Appendix 1 for a list of participating countries and centers) between May
Characteristics of the study group
Of the 3147 patients enrolled in the SOAP study, 1729 (54.9%) were discharged to the general floor, 359 (1.4%) to intermediate-care units, 240 (7.6%) to other acute care facilities, 130 (4.1%) to another hospital, and 105 (3.3%) were discharged home or admitted to a long-term facility. The characteristics of the whole population and those discharged to the general floor (study group, n = 1729) are presented in Table 1. Of the 1729 patients discharged to the general floor, 125 (4%) patients
Discussion
In this large cohort, 4% of patients discharged from the ICU died on the general floor. Post-ICU mortality rates varied from 3% to 8% in the contributing countries. In addition to the severity of illness and comorbidities on ICU admission, the presence of sepsis at any time during the ICU stay and organ dysfunction at ICU discharge, as assessed by the SOFA score, were all independently associated with an increased risk of post-ICU death on the hospital floor.
The quoted incidence of post-ICU
Conclusion
This large international study identified age, medical admission, and preexisting comorbidities on ICU admission, sepsis, and organ system failure as important independent risk factors for in-hospital post-ICU death. These data may help in risk stratification and identification of potentially inappropriate early discharges from the ICU.
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Endorsed by the European Society for Intensive Care Medicine (Brussels, Belgium), and supported by an unlimited grant from Abbott (Chicago, IL), Baxter (Deerfield, IL), Eli Lilly (Indianapolis IN), GlaxoSmithKline (Brentford, Essex, UK), and NovoNordisk.