Who Dies after ICU Discharge? Retrospective Analysis of Prognostic Factors for In-Hospital Mortality of ICU Survivors

Abstract

We investigated the causes of inpatient death after intensive care unit (ICU) discharge and determined predictors of in-hospital mortality in Korea. Using medical ICU registry data of Seoul National University Hospital, we performed a retrospective cohort study involving patients who were discharged alive from their first ICU admission with at least 24 hours of ICU length of stay (LOS). From January 2011 to August 2013, 723 patients were admitted to ICU and 383 patients were included. The estimated in-hospital mortality rate was 11.7% (45/383). The most common cause of death was respiratory failure (n = 25, 56%) followed by sepsis and cancer progression; the causes of hospital death and ICU admission were the same in 64% of all deaths; sudden unexpected deaths comprised about one-fifth of all deaths. In order to predict in-hospital mortality among ICU survivors, multivariate analysis identified presence of solid tumor (odds ratio [OR], 4.06; 95% confidence interval [CI], 2.01–8.2; P < 0.001), hematologic disease (OR, 4.75; 95% CI, 1.51–14.96; P = 0.013), Sequential Organ Failure Assessment (SOFA) score upon ICU admission (OR, 1.08; 95% CI, 0.99–1.17; P = 0.075), and hemoglobin (Hb) level (OR, 0.67; 95% CI, 0.52–0.86; P = 0.001) and platelet count (Plt) (OR, 0.99; 95% CI, 0.99–1.00; P = 0.033) upon ICU discharge as significant factors. In conclusion, a significant proportion of in-hospital mortality is predictable and those who die in hospital after ICU discharge tend to be severely-ill, with comorbidities of hematologic disease and solid tumor, and anemic and thrombocytopenic upon ICU discharge.

Out-of-hours discharge from intensive care, in-hospital mortality and intensive care readmission rates: a systematic review and meta-analysis

“…We included 18 studies (14 papers and 4 conference abstracts) in the meta-analysis [ 1 , 2 , 5 , 8 – 11 , 15 – 18 , 35 – 41 ]. The 18 studies (9 multicentre and 9 single centre) included 1,191,178 patients.…”

“…Many studies that alone were not large enough to show a statistically significant effect (and could have been misinterpreted as there being no effect) contributed to our overall findings [9, 11, 16–18, 37–41]. One previous meta-analysis of the association between time of discharge from ICU and hospital mortality has been undertaken [46].…”

“…Where disease severity was reported by discharge time, studies differed in the assessment used. Where reported, most studies excluded patients discharged to another healthcare facility [ 5 , 9 , 11 , 17 , 18 , 35 , 37 , 40 , 41 ]. This introduces a potential bias if outcomes by discharge time differ in this group.…”

Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

“…In the immediate period following step-down to the general surgical ward patients are at increased risk of morbidity and mortality. There is evidence to suggest that this is seen more frequently amongst individuals with significant comorbidities and poor performance status [ 17 – 19 ]. Communication between geriatric, surgical and critical care specialities, particularly at the point of transfer to ward-level care, could, therefore, provide benefit.…”

Challenges Experienced by Family Caregivers of the Adult Intensive Care Unit Patients in Korea: An Integrative Review

“…Among the quantitative studies, eight were descriptive cross-sectional surveys of psychological responses (i.e., burden, symptoms of depression, anxiety, post-traumatic stress, and burnout) and needs and satisfaction associated with the ICU experiences of family members. Six intervention studies tested a modified family visitation policy ( n = 1) (Lee & Kang, 2011), methods of providing ICU orientation and daily updates to patients’ families ( n = 3) (Choi et al, 2013; Lee & Lee, 2012; Yun & Kim, 2009), and transition support programs ( n = 2) (Lee et al, 2017; Yun et al, 2017). One study tested the validity of an instrument that measures transitional stress in family members (Oh et al, 2015).…”