Readmissions to General ICUs in a Geographic Area of Poland Are Seemingly Associated with Better Outcomes

Abstract

Background: Various factors can contribute to high mortality rates in intensive care units (ICUs). Here, we intended to define a population of patients readmitted to general ICUs in Poland and to identify independent predictors of ICU readmission. Methods: Data derived from adult ICU admissions from the Silesian region of Poland were analyzed. First-time ICU readmissions (≤30 days from ICU discharge after index admissions) were compared with first-time ICU admissions. Pre-admission and admission variables that independently influenced the need for ICU readmission were identified. Results: Among the 21,495 ICU admissions, 839 were first-time readmissions (3.9%). Patients readmitted to the ICU had lower mean APACHE II (21.2 ± 8.0 vs. 23.2 ± 8.8, p < 0.001) and TISS-28 scores (33.7 ± 7.4 vs. 35.2 ± 7.8, p < 0.001) in the initial 24 h following ICU admission, compared to first-time admissions. ICU readmissions were associated with lower mortality vs. first-time admissions (39.2% vs. 44.3%, p = 0.004). Independent predictors for ICU readmission included the admission from a surgical ward (among admission sources), chronic respiratory failure, cachexia, previous stroke, chronic neurological diseases (among co-morbidities), and multiple trauma or infection (among primary reasons for ICU admission). Conclusions: High mortality associated with first-time ICU admissions is associated with a lower mortality rate during ICU readmissions.

External validation of the sepsis severity score

“…Recently, Weigl et al, 49 after analyzing the national Polish ICU outcome database, reported a high observed ICU mortality of 43.5%. Grochla et al 50 hypothesized an explanation that the absence of clear futile therapy legislation, the unpopularity of advanced directives, the insufficiency of rapid response team implementation, the fear of legal consequences in cases of refusing ICU admission, the extreme pressure on ICU admissions due to the poor development of intermediate care, and the lack of funding for patients with a lower TISS-28 score (< 19 pts.) are responsible for this high mortality rate.…”