Impact of Intensive Care Unit Organ Failures on Mortality during the Five Years after a Critical Illness

Lone, Nazir; Walsh, Timothy

doi:10.1164/rccm.201201-0059oc

Cited by 62 publications

(53 citation statements)

References 38 publications

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“…We were surprised that the acute illness factors such as ICU admission illness severity and requirement for organ support had little or no influence on subsequent resource use. It is widely assumed that acute illness factors are important mediators in the causal pathway to post-critical illness morbidity, for example, through residual organ dysfunction or disability (24)(25)(26). Our data indicate that preillness factors, such as previous hospital resource use and comorbidity, most strongly influence subsequent hospital resource use.…”

Section: Discussionmentioning

confidence: 64%

Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

Lone

Gillies

Haddow

et al. 2016

Am J Respir Crit Care Med

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196

155

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Rationale: Survivors of critical illness experience significant morbidity, but the impact of surviving the intensive care unit (ICU) has not been quantified comprehensively at a population level.Objectives: To identify factors associated with increased hospital resource use and to ascertain whether ICU admission was associated with increased mortality and resource use.Methods: Matched cohort study and pre/post-analysis using national linked data registries with complete population coverage. The population consisted of patients admitted to all adult general ICUs during 2005 and surviving to hospital discharge, identified from the Scottish Intensive Care Society Audit Group registry, matched (1:1) with similar hospital control subjects. Five-year outcomes included mortality and hospital resource use. Confounder adjustment was based on multivariable regression and pre/post within-individual analyses.Measurements and Main Results: Of 7,656 ICU patients, 5,259 survived to hospital discharge (5,215 [99.2%] matched to hospital control subjects). Factors present before ICU admission (comorbidities/pre-ICU hospitalizations) were stronger predictors of hospital resource use than acute illness factors. In the 5 years after the initial hospital discharge, compared with hospital control subjects, the ICU cohort had higher mortality (32.3% vs. 22.7%; hazard ratio, 1.33; 95% confidence interval, 1.22-1.46; P , 0.001), used more hospital resources (mean hospital admission rate, 4.8 vs. 3.3/person/5 yr), and had 51% higher mean 5-year hospital costs ($25,608 vs. $16,913/patient). Increased resource use persisted after confounder adjustment (P , 0.001) and using pre/post-analyses (P , 0.001). Excess resource use and mortality were greatest for younger patients without significant comorbidity.Conclusions: This complete, national study demonstrates that ICU survivorship is associated with higher 5-year mortality and hospital resource use than hospital control subjects, representing a substantial burden on individuals, caregivers, and society.

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Section: Discussionmentioning

confidence: 64%

Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

Lone

Gillies

Haddow

et al. 2016

Am J Respir Crit Care Med

Self Cite

196

155

View full text Add to dashboard Cite

show abstract

“…However, high dropout rates are well described in the literature, primarily due to mortality, either in hospital or during the first few months in the community (9,12,(36)(37)(38)(39). From our data, an 18-month follow-up study on 100 survivors would require recruiting 303 patients on admission to ICU.…”

Section: Limitationsmentioning

confidence: 82%

An Exploratory Study of Long-Term Outcome Measures in Critical Illness Survivors: Construct Validity of Physical Activity, Frailty, and Health-Related Quality of Life Measures*

McNelly

Rawal

Shrikrishna

et al. 2016

Critical Care Medicine

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“…However, as our study is observational and not interventional, a causal relationship between AKI status and postdischarge outcomes cannot be inferred from these data alone. Risk factors for adverse events in ICU survivors include high ICU bed occupancy, time of day at ICU discharge, severity of illness scores, organ failure indices, and discharge facility (49)(50)(51)(52). It is well described that ICU survivors suffer significant long-term morbidity and mortality (53).…”

Section: Discussionmentioning

confidence: 99%

The Association of Acute Kidney Injury in the Critically Ill and Postdischarge Outcomes

Horkan

Purtle

Mendu

et al. 2015

Critical Care Medicine

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Patients who suffer acute kidney injury are among a high-risk group of ICU survivors for adverse outcomes. In patients treated with critical care who survive hospitalization, acute kidney injury is a robust predictor of subsequent unplanned hospital readmission. In critical illness survivors, acute kidney injury is also associated with the odds of 30-day postdischarge mortality and the risk of subsequent end-stage renal disease.

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Impact of Intensive Care Unit Organ Failures on Mortality during the Five Years after a Critical Illness

Cited by 62 publications

References 38 publications

Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

Five-Year Mortality and Hospital Costs Associated with Surviving Intensive Care

An Exploratory Study of Long-Term Outcome Measures in Critical Illness Survivors: Construct Validity of Physical Activity, Frailty, and Health-Related Quality of Life Measures*

The Association of Acute Kidney Injury in the Critically Ill and Postdischarge Outcomes

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