Sepsis and organ system failure are major determinants of post-intensive care unit mortality

Yasser Sakr, Jean-Louis Vincent, Esko Ruokonen, Mario Pizzamiglio, Etienne Installe, Konrad Reinhart, Rui Moreno et al.
Journal of Critical Care 2008, 23 (4): 475-83

PURPOSE: The aim of the study was to investigate predictors of post-intensive care unit (ICU) in-hospital mortality with special emphasis on the impact of sepsis and organ system failure.

METHODS: This study is a subanalysis of the database from the observational Sepsis Occurrence in Acutely Ill Patients study conducted in 198 ICUs in 24 European countries between May 1 and May 15, 2002. Potential predictors of post-ICU mortality were considered at 3 levels: admission status, procedures and therapy during the ICU stay, and status at ICU discharge.

RESULTS: Of the 3147 patients included in the Sepsis Occurrence in Acutely Ill Patients study, 1729 (54.9%) were discharged to the general floor (study group) and 125 of these died (overall post-ICU hospital mortality rate, 4%); 26 (20.8%) died already the first day on the floor. Nonsurvivors were older, had higher incidence of hematologic cancer and cirrhosis, and greater Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score on ICU admission; they were also more likely to have been admitted for medical reasons than survivors. In a multivariate forward stepwise logistic regression analysis, age, hematologic cancer, cirrhosis, simplified acute physiology score II on admission, medical admission, sepsis at any time during ICU stay, and organ dysfunction at ICU discharge were all independently associated with a greater risk of post-ICU death.

CONCLUSIONS: This large international study identified not only age, medical admission, and preexisting comorbidities on ICU admission but also sepsis and organ system failure as important independent risk factors for in-hospital post-ICU death.


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