INTENSIVE CARE UNIT PATIENTS’ MORTALITY INDICATORS AND ASSOCIATED PARAMETERS

Authors

  • R PERVAIZ Department of Internal & Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
  • SZ BUKHARI Department of Critical Care Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
  • LH ISSA Department of Critical Care Medicine, Mediclinic City Hospital, Dubai, UAE
  • H AHMED Department of Internal & Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
  • T SAGHEER Department of Internal & Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
  • A QURBAN Department of Internal & Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
  • R RASHEED Department of Internal & Critical Care Medicine, Bahria International Hospital, Lahore, Pakistan
  • . ADEEL Department of Critical Care Nursing, Bahria International Hospital, Lahore, Pakistan
  • . ARISH Department of Critical Care Nursing, Bahria International Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v3i01.28

Keywords:

Age Factors, Charlson Comorbidity Index, Delirium, Glycemic Index, Intensive Care Units, Mechanical Ventilation, Mortality, Sepsis.

Abstract

Background: Several risk factors have been associated with the intensive care unit (ICU) mortality. Identifying these factors can help predict and reduce ICU mortality rates. Objective: To determine the mortality rate, identify contributing factors, and conduct a survival analysis in ICU patients. Study Design: A retrospective cohort study. Setting: Bahria International Hospital Lahore, & Services Institute of Medical Sciences, Lahore. Duration of Study: January 1, 2021, to December 5, 2022. Methods: A retrospective study was conducted in the medical & surgical ICUs. Data on delirium prevalence, socioeconomic status, and clinical conditions were collected retrospectively. The information included patient admission details, ICU diagnoses, hospital stays, presence of pressure ulcers, signs of dehydration, fluid balance, urine output, skin conditions, diabetes status, temperature, oro-gastric feeding, and ventilatory support. Patients were divided into two groups based on their hospitalisation outcomes: Group A for patients who died and Group B for those who were discharged/shifted from the ICU. Results: A total of 185 patients met the inclusion criteria. The study found that 18.9% of hospitalisations resulted in death. Patients in the death group were older (54 ± 16 years vs. 46 ± 19 years, p = 0.02) and were more likely to be transferred from hospital units after a sepsis diagnosis (57.1% vs. 20.1%, p = 0.01). Delirium was observed in 54.2% of individuals in the death group compared to 47.3% in the discharge group (p = 0.14). The Charlson score was higher in the death group (2.4 ± 2.78 vs. 1.71 ± 2.41, p = 0.04). Multifactorial analysis using the Cox regression model revealed that patients admitted via the emergency room (HR 0.39, p = 0.007) and those with an abnormal glycemic index (HR 1.71, p = 0.041) had higher odds of dying in the ICU. Conclusion: Older age, medical diagnosis of sepsis, and admission from other hospital units were associated with increased ICU mortality. Additionally, water and electrolyte imbalances, variations in glycemic index with tube feeding, mechanical ventilation, and higher Charlson scores were correlated with increased mortality.

References

Soares Pinheiro FGdM, Santana Santos E, Barreto IDdC, Weiss C, Vaez AC, Oliveira JC, et al. Mortality predictors and associated factors in patients in the intensive care unit: a cross-sectional study. Critical Care Research and Practice. 2020;2020.

Awad A, Bader-El-Den M, McNicholas J, Briggs J, El-Sonbaty Y. Predicting hospital mortality for intensive care unit patients: time-series analysis. Health informatics journal. 2020;26(2):1043-59.

Park J, Kwon Y-S, Kim H-A, Kwon D-H, Hwang J, Jang S-H, et al. Clinical implications of neurological comorbidities and complications in ICU patients with COVID-19. Journal of clinical medicine. 2021;10(11):2281.

Patel U, Malik P, Usman MS, Mehta D, Sharma A, Malik FA, et al. Age-adjusted risk factors associated with mortality and mechanical ventilation utilization amongst COVID-19 hospitalizations—a systematic review and meta-analysis. SN comprehensive clinical medicine. 2020;2:1740-9.

Russell JA, Gordon AC, Williams MD, Boyd JH, Walley KR, Kissoon N, editors. Vasopressor therapy in the intensive care unit. Seminars in respiratory and critical care medicine; 2021: Thieme Medical Publishers, Inc.

Hanna M, Balintescu A, Glassford N, Lipcsey M, Eastwood G, Oldner A, et al. Glycemic lability index and mortality in critically ill patients—A multicenter cohort study. Acta Anaesthesiologica Scandinavica. 2021;65(9):1267-75.

Mendes-Rodrigues C, Gomes FA, de Brito Röder DVD, Cunha TM, Mendonça GS, de Azevedo Zago KS, et al. Predictors of mortality in the intensive care unit for adult patients admitted on mechanical ventilation: admission profile. International Journal for Innovation Education and Research. 2021;9(5):121-39.

Sanchez D, Brennan K, Al Sayfe M, Shunker S-A, Bogdanoski T, Hedges S, et al. Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study. Critical Care. 2020;24:1-8.

Siddika N, Anowar MN, Islam MS, Mallick DR. Characteristics of Adult Intensive Care Unit Patients at a University Hospital. Open Access Library Journal. 2023;10(3):1-15.

Khan MA, Shahbaz H, Noorali AA, Ehsan AN, Zaki M, Asghar F, et al. Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system. Critical Care. 2022;26(1):209.

Drosdowsky A, Gough K. The Charlson Comorbidity Index: problems with use in epidemiological research. Journal of clinical epidemiology. 2022;148:174-7.

Quah P, Li A, Phua J. Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature. Critical care. 2020;24:1-4.

de Albuquerque JM, da Silva RFA, de Souza RFF. Perfil epidemiológico e seguimento após alta de pacientes internados em unidade de terapia intensiva. Cogitare Enfermagem. 2017;22(3).

Arrieta EJSM, Álvarez GJ, Bellver BQ, Monedero MEB, Muñoz IF, Cuenca SL. Análisis de los factores implicados en la evolución de los pacientes mayores de 80 años, ingresados en la unidad de cuidados intensivos:¿ debemos cambiar nuestro proceder? Revista Española de Geriatría y Gerontología. 2022;57(3):182-5.

Kitamura A, Seino S, Abe T, Nofuji Y, Yokoyama Y, Amano H, et al. Sarcopenia: prevalence, associated factors, and the risk of mortality and disability in Japanese older adults. Journal of cachexia, sarcopenia and muscle. 2021;12(1):30-8.

Hillary RF, Stevenson AJ, McCartney DL, Campbell A, Walker RM, Howard DM, et al. Epigenetic measures of aging predict the prevalence and incidence of leading causes of death and disease burden. Clinical epigenetics. 2020;12:1-12.

Modra L, Higgins A, Vithanage R, Abeygunawardana V, Bailey M, Bellomo R. Sex differences in illness severity and mortality among adult intensive care patients: A systematic review and meta-analysis. Journal of critical care. 2021;65:116-23.

Fleischmann-Struzek C, Mellhammar L, Rose N, Cassini A, Rudd K, Schlattmann P, et al. Incidence and mortality of hospital-and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. Intensive care medicine. 2020;46:1552-62.

Markwart R, Saito H, Harder T, Tomczyk S, Cassini A, Fleischmann-Struzek C, et al. Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive care medicine. 2020;46:1536-51.

Jordan EA, Moore SC. Enteral nutrition in critically ill adults: A literature review of protocols. Nursing in critical care. 2020;25(1):24-30.

Núñez SA, Roveda G, Zárate MS, Emmerich M, Verón MT. Ventilator-associated pneumonia in patients on prolonged mechanical ventilation: description, risk factors for mortality, and performance of the SOFA score. Jornal Brasileiro de Pneumologia. 2021;47:e20200569.

Fang W-F, Fang Y-T, Huang C-H, Chen Y-M, Chang Y-C, Lin C-Y, et al. Risk factors and associated outcomes of ventilator-associated events developed in 28 days among sepsis patients admitted to the intensive care unit. Scientific Reports. 2020;10(1):12702.

Eckert I, Kumbier MC, Silva FM, Franzosi OS, de Almeida JC. Association of specialized enteral nutrition with glycemic control and clinical outcomes in critically ill patients: a meta-analysis of randomized controlled trials. Clinical Nutrition. 2021;40(6):3940-9.

Guo J-Y, Chou R-H, Kuo C-S, Chao T-F, Wu C-H, Tsai Y-L, et al. The paradox of the glycemic gap: does relative hypoglycemia exist in critically ill patients? Clinical Nutrition. 2021;40(7):4654-61.

Robles Arévalo A, Maley JH, Baker L, da Silva Vieira SM, da Costa Sousa JM, Finkelstein S, et al. Data-driven curation process for describing the blood glucose management in the intensive care unit. Scientific Data. 2021;8(1):80.

Krewulak KD, Stelfox HT, Ely EW, Fiest KM. Risk factors and outcomes among delirium subtypes in adult ICUs: a systematic review. Journal of critical care. 2020;56:257-64.

Seiler A, Blum D, Hertler C, Schettle M, Zipser CM, Bode L, et al. Death in delirious palliative-care patients occurs irrespective of age: A prospective, observational cohort study of 229 delirious palliative-care patients. Palliative & supportive care. 2021;19(3):274-82.

Downloads

Published

2023-03-10

How to Cite

PERVAIZ , R., BUKHARI , S., ISSA , L., AHMED , H., SAGHEER , T., QURBAN , A., RASHEED , R., ADEEL, ., & ARISH, . (2023). INTENSIVE CARE UNIT PATIENTS’ MORTALITY INDICATORS AND ASSOCIATED PARAMETERS. Pakistan Journal of Intensive Care Medicine, 3(01), 28. https://doi.org/10.54112/pjicm.v3i01.28

Issue

Section

Original Research Articles

Most read articles by the same author(s)

<< < 1 2