Six to 25 percent of patients discharged alive from the intensive care unit
(ICU) die before hospital discharge
. Although this post-ICU mortality
may indicate premature discharge
from a full ICU or suboptimal management in the ICU or ward, another factor may be discharge
from the ICU as part of a decision to limit treatment of hopelessly ill patients. We investigated determinants of post-ICU mortality
, with special attention to this factor.
, database study.
Seven ICUs in or near Paris, France
A total of 1,385 patients who were discharged alive from an ICU after a stay of ≥48 hrs; 150 (10.8%) died before hospital discharge
. Decisions to withhold or withdraw life-sustaining treatments were implemented in the ICUs in 80 patients, including 47 (58.7%) who died before hospital discharge
Measurements and Main Results
In the univariate analysis, post-ICU mortality
was associated with advanced age, poor chronic health status, severe comorbidities, severity
and organ failure scores (Simplified Acute Physiology Score II, sepsis-related organ failure assessment, and Logistic Organ Dysfunction at admission and at ICU discharge
), decisions to withhold or withdraw life-sustaining treatments, and Omega score (reflecting ICU resource utilization and length of ICU stay). Multivariate stepwise logistic regression identified five independent determinants of post-ICU mortality
: McCabe class 1 (odds ratio, 0.388 [95% confidence interval, 0.26–0.58]), transfer from a ward (odds ratio, 1.89 [95% confidence interval, 1.27–2.80]), Simplified Acute Physiology Score II score at admission >36 (odds ratio, 1.57 [95% confidence interval, 1.6–2.33]), decisions to withhold or withdraw life-sustaining treatments (odds ratio, 9.64 [95% confidence interval, 5.75–16.6]), and worse sepsis-related organ failure assessment score at discharge
(odds ratio, 1.11 [95% confidence interval, 1.03–1.18] per point).
More than 10% of ICU survivors died before hospital discharge
. Determinants of post-ICU mortality
included variables reflecting patient status before and during the ICU stay. However, the most powerful predictor of post-ICU mortality
was the decision to withhold or withdraw life-sustaining treatments in the ICU, suggesting that the decision has been made not to use the unique services of the ICU for these patients.