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Critical Care
Published in: Critical Care 1/2024

Open Access 01-12-2024 | Cardiogenic Shock | Research

Association between intensive care unit nursing grade and mortality in patients with cardiogenic shock and its cost-effectiveness

Authors: Ki Hong Choi, Danbee Kang, Jin Lee, Hyejeong Park, Taek Kyu Park, Joo Myung Lee, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Juhee Cho, Jeong Hoon Yang

Published in: Critical Care | Issue 1/2024

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Abstract

Background

Despite the high workload of cardiac intensive care unit (ICU), there is a paucity of evidence on the association between nurse workforce and mortality in patients with cardiogenic shock (CS). This study aimed to evaluate the prognostic impact of the ICU nursing grade on mortality and cost-effectiveness in CS.

Methods

A nationwide analysis was performed using the K-NHIS database. Patients diagnosed with CS and admitted to the ICU at tertiary hospitals were enrolled. ICU nursing grade was defined according to the bed-to-nurse ratio: grade1 (bed-to-nurse ratio < 0.5), grade2 (0.5 ≤ bed-to-nurse ratio < 0.63), and grade3 (0.63 ≤ bed-to-nurse ratio < 0.77) or above. The primary endpoint was in-hospital mortality. Cost-effective analysis was also performed.

Results

Of the 72,950 patients with CS, 27,216 (37.3%) were in ICU nursing grade 1, 29,710 (40.7%) in grade 2, and 16,024 (22.0%) in grade ≥ 3. The adjusted-OR for in-hospital mortality was significantly higher in patients with grade 2 (grade 1 vs. grade 2, 30.6% vs. 37.5%, adjusted-OR 1.14, 95% CI1.09–1.19) and grade ≥ 3 (40.6%) with an adjusted-OR of 1.29 (95% CI 1.23–1.36) than those with grade 1. The incremental cost-effectiveness ratio of grade1 compared with grade 2 and ≥ 3 was $25,047/year and $42,888/year for hospitalization and $5151/year and $5269/year for 1-year follow-up, suggesting that grade 1 was cost-effective. In subgroup analysis, the beneficial effects of the high-intensity nursing grade on mortality were more prominent in patients who received CPR or multiple vasopressors usage.

Conclusions

For patients with CS, ICU grade 1 with a high-intensity nursing staff was associated with reduced mortality and more cost-effectiveness during hospitalization compared to grade 2 and grade ≥ 3, and its beneficial effects were more pronounced in subjects at high risk of CS.

Graphical abstract

Appendix
Available only for authorised users
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Metadata
Title
Association between intensive care unit nursing grade and mortality in patients with cardiogenic shock and its cost-effectiveness
Authors
Ki Hong Choi
Danbee Kang
Jin Lee
Hyejeong Park
Taek Kyu Park
Joo Myung Lee
Young Bin Song
Joo-Yong Hahn
Seung-Hyuk Choi
Hyeon-Cheol Gwon
Juhee Cho
Jeong Hoon Yang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2024
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-024-04880-9

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