Work

The critical illness mortality inflection point during prolonged Surgical ICU length of stay

Year: 2018

Type: article

Abstract: Background: The purpose of this study is to determine the relationship between ICU Length of Stay (LOS) and mortality in a surgical population and evaluate predictors of mortality at a LOS inflection point. Methods:All patients admitted to a surgical ICU from July 2003 through June 2014 at a well-established, urban, academic medical center were retrospectively reviewed via a prospective registry.In-hospital mortality rates were determined and plotted for each ICU LOS day through the first 6 weeks.Identified mortality curve slope change was used to identify an at-risk cohort.Using the most recent one-year data, risk factors including APACHE II were recalculated on the inflection point day to assess metric validity.Results: 19,061 ICU admissions were assessed.Mortality followed a sigmoid curve with a significant rise occurring during week two that plateaued by ICU day 14.Mortality rates based on LOS ≤ 14 days vs. > 14 days significantly differed (4.23% vs. 21.6%,p<0.001).There were 130 patients with a >14-day LOS in the most recent year cohort.Re-calculated APACHE II scores on ICU day 14 were significantly predictive of mortality, 23.64 for deaths (95% CI: 21.36-25.92)vs. 16.35 for survivors (95% CI: 15.50-17.20),p<0.001.Additional independent day 14 mortality predictors included pressor use (44.0% vs. 21.9%,p<0.02), bacteremia (44.0% vs. 16.2%,p<0.002), active malignancy (40.0% vs. 16.2%,p<0.005), and dialysis (36.0% vs. 10.5%, p<0.001).Conclusions: Mortality significantly increases after 14 days in a surgical ICU.Recalculation of APACHE II score at this inflection point is valid and correlative of mortality.This methodology can be helpful for informing decision making for patients who require ICU care exceeding 14 days duration.

Source: Pulmonary and Critical Care Medicine

DOI: 10.15761/pccm.1000144