Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study

Abstract

Objective Intensive care unit (ICU) discharge is a decision process that is usually performed subjectively. We evaluated whether a subjective score (Sabadell score) is associated with hospital outcomes. Methods We conducted a prospective cohort study from August 2014 to May 2015 at a tertiary-care private hospital in Brazil. We analyzed 425 patients who were discharged alive from the ICU to the wards. We used univariate and multivariate analysis to identify risk factors associated with a composite endpoint of worse outcomes (later ICU readmission or ward death) during the same hospitalization. Results Forty-three patients (10.1%) were readmitted after ICU discharge, and 19 died in the ward. Compared with patients with successful outcomes, those with the composite endpoint were older and more severely ill, had a nonsurgical reason for hospitalization, more frequently came from the ward, were less frequently independent during daily activities, had sepsis, had higher C-reactive protein concentrations at ICU admission, and had higher Sabadell scores at discharge. The multivariate analysis showed that sepsis and the Sabadell score were independently and significantly associated with worse outcomes. Conclusion Sepsis at admission and the Sabadell score were predictors of worse hospital outcomes. The Sabadell score might be a promising predictive tool.

Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study

“…The prevalence of death in infected patients who survived the ICU was high in our study. The increased risk of post ICU mortality in patients with infections has been pointed out by other authors [ 23 - 26 ]. It is estimated that infection by MDR increases hospital mortality by approximately 1.7 times [ 23 , 24 ], which is similar to the results of the current study.…”

Predictive Modeling for Readmission to Intensive Care: A Systematic Review

“…Twenty-one studies used ICU readmission within windows that ranged from six hours to 30 days as the primary endpoint. Thirteen studies used a combined endpoint that included death (14, 15, 18, 22, 24–29, 42, 44, 45), cardiac arrest (14, 29), or rapid response team deployment (27) in addition to ICU readmission. One study evaluated ICU readmission as both a single and combined endpoint (26).…”

“…Two studies selected predictor variables from a larger pool based on the greatest differences between readmitted and nonreadmitted patient cohorts ( 18 , 21 ). Validation was performed in 25 studies—internal validation in 19 articles and both internal and external validation in six articles ( 14 , 17 , 21 , 29 , 42 , 45 ). Seventeen studies used discretization to transform continuous variables into categorical variables.…”

“…Thirty-three studies were included in the final analysis, as summarized in Supplemental Table 1 (http://links.lww.com/CCX/B130) (14–46). Twenty-five studies recruited patients from a single center; eight studies (14–19, 29, 42) reported results from two or more centers.…”

“…The importance of homogeneity was substantiated by several studies with a low risk of bias ( Supplemental Table 3 , http://links.lww.com/CCX/B130 ) ( 14 – 25 , 27 – 30 , 32 , 37 – 43 , 45 , 46 ). While developing distinct models for each patient subgroup may prove cumbersome if performed to the extreme, limiting future studies to a single surgery type (e.g., cardiac surgery) or a single initial complaint (e.g., respiratory distress) may lead to better overall model performance.…”