Top

Published in:

01-01-2005 | Original

Post-ICU mortality in critically ill infected patients: an international study

Authors: Élie Azoulay, Corinne Alberti, Isabelle Legendre, Christian Brun Buisson, Jean Roger Le Gall, for the European Sepsis Group

Published in: Intensive Care Medicine | Issue 1/2005

Abstract

Objective

To determine the incidence and risk factors for post-ICU mortality in patients with infection.

Design and setting

International observational cohort study including 28 ICUs in eight countries.

Patients

All 1,872 patients discharged alive from the ICU over a 1-year period were screened for infection at ICU admission and daily throughout the ICU stay. Outcomes at ICU and hospital discharge were recorded.

Measurements and results

Post-ICU death occurred in 195 (10.4%) patients and was associated in the multivariable analysis with age, chronic respiratory failure, immunosuppression, cirrhosis, Simplified Acute Physiology Score II on the first day with infection, and LOD score at ICU discharge. Post-ICU death was more common among medical patients and patients with hospital-acquired infection or microbiologically documented infection and was less common in patients with pneumonia.

Conclusions

Post-ICU death in patients with infection was within previously reported ranges in overall ICU populations. The main risk factors were patient and infection characteristics, severity at ICU admission, and persistent organ dysfunction at ICU discharge. Further interventions such as further ICU management, discharge to a step-down unit, or follow-up by intensivists on the ward should be evaluated in patients with a high risk of post-ICU mortality

Available only for authorised users

Friedman G, Silva E, Vincent JL (1998) Has the mortality of septic shock changed with time. Crit Care Med 26:2078–2086PubMed

Angus DC, Wax RS (2001) Epidemiology of sepsis: an update. Crit Care Med 29:S109–S116CrossRefPubMed

Centers for Disease Control (1990) Increase in national hospital discharge survey rates for septicemia: United States, 1979–1987. MMWR Morb Mortal Wkly Rep 39:31–34PubMed

Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, Sicignano A, Palazzo M, Moreno R, Boulme R, Lepage E, Le Gall R (2002) Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 28:108–121PubMed

Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310CrossRefPubMed

Calandra T (2001) Pathogenesis of septic shock: implications for prevention and treatment. J Chemother 13 [suppl 1]:173–180

Brun-Buisson C, Doyon F, Carlet J (1996) Bacteremia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals. French Bacteremia-Sepsis Study Group. Am J Respir Crit Care Med 154:617–624PubMed

Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD Ely EW, Fisher CJ Jr (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709CrossRefPubMed

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377CrossRefPubMed

10.

Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871PubMed

11.

Zeni F, Freeman B, Natanson C (1997) Anti-inflammatory therapies to treat sepsis and septic shock: a reassessment. Crit Care Med 25:1095–1100PubMed

12.

Abraham E (1999) Why immunomodulatory therapies have not worked in sepsis. Intensive Care Med 25:556–566CrossRefPubMed

13.

Keenan SP, Dodek P, Chan K, Hogg RS, Craib KJ, Anis AH, Spinelli JJ (2002) Intensive care unit admission has minimal impact on long-term mortality. Crit Care Med 30:501–507PubMed

14.

Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB (1996) Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 276:1253–1258CrossRefPubMed

15.

Goldhill DR, Sumner A (1998) Outcome of intensive care patients in a group of British intensive care units. Crit Care Med 26:1337–1345CrossRefPubMed

16.

Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP (1993) Intensive Care Society’s APACHE II study in Britain and Ireland. II. Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method. BMJ 307:977–981PubMed

17.

Azoulay E, Adrie C, de Lassence A, Pochard F, Moreau D, Thierry G, Cheval C, Moine P, Garrouste-Orgeas M, Alberti C, Cohen Y, Timsit J (2003) Determinants of post ICU mortality: a multicentre study. Crit Care Med 31:428–432PubMed

18.

Bion J (1995) Rationing intensive care. BMJ 310:682–683PubMed

19.

Ridley S, Purdie J (1992) Cause of death after critical illness. Anaesthesia 47:116–119PubMed

20.

Wallis CB, Davies HT, Shearer AJ (1997) Why do patients die on general wards after discharge from intensive care units? Anaesthesia 52:9–14PubMed

21.

Goldfrad C, Rowan K (2000) Consequences of discharges from intensive care at night. Lancet 355:1138–1142CrossRefPubMed

22.

Daly K, Beale R, Chang RW (2001) Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model. BMJ 322:1274–1276CrossRefPubMed

23.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMed

24.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed

25.

Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810PubMed

26.

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140PubMed

27.

Sauerbrei W, Schumacher M (1992) A bootstrap resampling procedure for model building: application to the Cox regression model. Stat Med 11:2093–2109PubMed

28.

Marshall RJ (2001) The use of classification and regression trees in clinical epidemiology. J Clin Epidemiol 54:603–609CrossRefPubMed

29.

Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP (1993) Intensive Care Society’s APACHE II study in Britain and Ireland. I. Variations in case mix of adult admissions to general intensive care units and impact on outcome. BMJ 307:972–977PubMed

30.

Latour J, Lopez-Camps V, Rodriguez-Serra M, Giner JS, Nolasco A, Alvarez-Dardet C (1990) Predictors of death following ICU discharge. Intensive Care Med 16:125–127PubMed

31.

Munn J, Willatts SM, Tooley MA (1995) Health and activity after intensive care. Anaesthesia 50:1017–1021PubMed

32.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMed

33.

Fried TR, Bradley EH, Towle VR, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346:1061–1066CrossRefPubMed

34.

Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 274:968–974PubMed

35.

Perl TM, Dvorak L, Hwang T, Wenzel RP (1995) Long-term survival and function after suspected gram-negative sepsis. JAMA 274:338–345PubMed

36.

Sasse KC, Nauenberg E, Long A, Anton B, Tucker HJ, Hu TW (1995) Long-term survival after intensive care unit admission with sepsis. Crit Care Med 23:1040–1047CrossRefPubMed

37.

Dodek P, Herrick R, Phang PT (2000) Initial management of trauma by a trauma team: effect on timeliness of care in a teaching hospital. Am J Med Qual 15:3–8PubMed

Title: Post-ICU mortality in critically ill infected patients: an international study
Authors: Élie Azoulay
Corinne Alberti
Isabelle Legendre
Christian Brun Buisson
Jean Roger Le Gall
for the European Sepsis Group
Publication date: 01-01-2005
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2484-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Post-ICU mortality in critically ill infected patients: an international study

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2005

Prediction of responses to various stimuli during sedation: a comparison of three EEG variables

Neurological outcome after bacterial meningitis: bridging the gap from molecules to behavior

Total and ionized serum magnesium in critically ill patients

Differential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humans

Dexamethasone decreases neurological sequelae and caspase activity

Steroid-induced myopathy in patients intubated due to exacerbation of chronic obstructive pulmonary disease