End-of-life management in intensive care units: a multicentre observational prospective cohort study

Alliprandini, Marina; Ferrandin, Andressa; Fernandes, Adriana; Belim, Mariana; Jorge, M. Núñez-Córdoba; Colombo, Bruno; Yaguchi, Jordana; Chung, Thais Tsing; Jorge, Amaury César; Duarte, Pericles

doi:10.5114/ait.2019.91189

Cited by 14 publications

(14 citation statements)

References 23 publications

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“…The higher mortality in Polish ICUs compared with other European countries [25], which has been under debate in recent years, is rather due to differences in patient populations, indications for ICU admission, the availability of ICU beds and the organization of end-of-life care in Poland. This is also due to the skeptical attitude of some practitioners regarding guidelines on futile therapy [26,27] and official ICU admission criteria [28]. Although patients admitted to Polish ICUs are more often at higher risk of death compared with other countries, ICU mortality observed in the Silesian Registry of Intensive Care Units was lower than that predicted by the APACHE II score [29].…”

Section: Discussionmentioning

confidence: 99%

Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

et al. 2020

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Background There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed. Results Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12–24), 67 (36.5–88) and 44 (27–56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1–46.0), 18.5% (IQR 3.8–41.8) and 34.8% (IQR 7.9–59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p < 0.05): APACHE II (AUC = 0.78; 95%CI 0.73–0.83), APACHE III (AUC = 0.79; 95%CI 0.74–0.84) and SAPS II (AUC = 0.79; 95%CI 0.74–0.84); as well as mortality after hospital discharge (p < 0.05): APACHE II (AUC = 0.71; 95%CI 0.64–0.78), APACHE III (AUC = 0.72; 95%CI 0.65–0.78) and SAPS II (AUC = 0.69; 95%CI 0.62–0.76), with no statistically significant difference between the scores (p > 0.05). The calibration of the scores was good. Conclusions All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

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Section: Discussionmentioning

confidence: 99%

Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

et al. 2020

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“…This problem does not only concern Poland. It has been recently shown that adequate palliative care may be introduced with great heterogeneity and delay in other countries as well [ 39 ]. As a result, many patients with severe DoC remain in the ICU and are sometimes actively treated.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and clinical characteristics of patients discharged from the ICU in a vegetative or minimally conscious state

et al. 2021

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Purpose A significant percentage of patients are discharged from intensive care units (ICU) with disorders of counciousness (DoC). The aim of this retrospective, case-control study was to compare patients discharged from the ICU in a vegetative state (VS) or minimally conscious state (MCS) and the rest of ICU survivors, and to identify independent predictors of DoC among ICU survivors. Methods Data from 14,368 adult ICU survivors identified in a Silesian Registry of Intensive Care Units (active in the Silesian Region of Poland between October 2010 and December 2019) were analyzed. Patients discharged from the ICU in a VS or MCS were compared to the remaining ICU survivors. Pre-admission and admission variables that independently influence ICU discharge with DoC were identified. Results Among the 14,368 analyzed adult ICU survivors, 1,064 (7.4%) were discharged from the ICU in a VS or MCS. The percentage of patients discharged from the ICU with DoC was similar in all age groups. Compared to non- DoC ICU patients, they had a higher mean APACHE II and SAPS III score at admission. Independent variables affecting ICU discharge with DoC included unconsciousness at ICU admission, cardiac arrest and craniocerebral trauma as primary cause of ICU admission, as well as a history of previous chronic neurological disorders and cerebral stroke (p<0.001). Conclusion Discharge in a VS and MCS was relatively frequent among ICU survivors. Discharge with DoC was more likely among patients who were unconscious at admission and admitted to the ICU due to cardiac arrest or craniocerebral trauma.

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“…The higher mortality in Polish ICUs compared with other European countries (25), which has been under debate in recent years, is rather due to differences in patient populations, indications for ICU admission, the availability of ICU beds and the organization of end-of-life care in Poland. This is also due to the skeptical attitude of some practitioners regarding guidelines on futile therapy (26,27) (30). The cause of this phenomenon appears to be complex, and may result from substantial differences between the patient population in our unit (mixed admissions, including post-operative cases as the rst priority) and the target populations these prognostic models were developed for.…”

Section: Discussionmentioning

confidence: 99%

Validation of APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed intensive care unit in Poland: a cohort study

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Ziębińska

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et al. 2020

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Background. There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed.Results. Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12-24), 67 (36.5-88) and 44 (27-56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1-46.0), 18.5% (IQR 3.8-41.8) and 34.8% (IQR 7.9-59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p<0.05): APACHE II (AUC=0.78; 95%CI 0.73-0.83), APACHE III (AUC=0.79; 95%CI 0.74-0.84) and SAPS II (AUC=0.79; 95%CI 0.74-0.84); as well as mortality after hospital discharge (p<0.05): APACHE II (AUC=0.71; 95%CI 0.64-0.78), APACHE III (AUC=0.72; 95%CI 0.65-0.78) and SAPS II (AUC=0.69; 95%CI 0.62-0.76), with no statistically significant difference between the scores (p>0.05). The calibration of the scores was good.Conclusions. All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

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End-of-life management in intensive care units: a multicentre observational prospective cohort study

Cited by 14 publications

References 23 publications

Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

Epidemiology and clinical characteristics of patients discharged from the ICU in a vegetative or minimally conscious state

Validation of APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed intensive care unit in Poland: a cohort study

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