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In-Hospital Mortality and Long-Term Survival of Patients With Acute Intoxication Admitted to the ICU*

Brandenburg, Raya BSc1; Brinkman, Sylvia PhD2,3; de Keizer, Nicolette F. PhD2,3; Meulenbelt, Jan MD, PhD1,4,5; de Lange, Dylan W. MD, PhD1,3,4

doi: 10.1097/CCM.0000000000000245
Clinical Investigations

Objective: To assess in-hospital and long-term mortality of Dutch ICU patients admitted with an acute intoxication.

Design: Cohort of ICU admissions from a national ICU registry linked to records from an insurance claims database.

Setting: Eighty-one ICUs (85% of all Dutch ICUs).

Patients: Seven thousand three hundred thirty-one admissions between January 1, 2008, and October 1, 2011.

Interventions: None.

Measurements and Main Results: Kaplan-Meier curves were used to compare the unadjusted mortality of the total intoxicated population and for specific intoxication subgroups based on the Acute Physiology and Chronic Health Evaluation IV reasons for admission: 1) alcohol(s), 2) analgesics, 3) antidepressants, 4) street drugs, 5) sedatives, 6) poisoning (carbon monoxide, arsenic, or cyanide), 7) other toxins, and 8) combinations. The case-mix adjusted mortality was assessed by the odds ratio adjusted for age, gender, severity of illness, intubation status, recurrent intoxication, and several comorbidities. The ICU mortality was 1.2%, and the in-hospital mortality was 2.1%. The mortality 1, 3, 6, 12, and 24 months after ICU admission was 2.8%, 4.1%, 5.2%, 6.5%, and 9.3%, respectively. Street drugs had the highest mortality 2 years after ICU admission (12.3%); a combination of different intoxications had the lowest (6.3%). The adjusted observed mortality showed that intoxications with street drugs and “other toxins” have a significant higher mortality 1 month after ICU admission (odds ratioadj = 1.63 and odds ratioadj= 1.73, respectively). Intoxications with alcohol or antidepressants have a significant lower mortality 1 month after ICU admission (odds ratioadj = 0.50 and odds ratioadj = 0.46, respectively). These differences were not found in the adjusted mortality 3 months upward of ICU admission.

Conclusions: Overall, the mortality 2 years after ICU admission is relatively low compared with other ICU admissions. The first 3 months after ICU admission there is a difference in mortality between the subgroups, not thereafter. Still, the difference between the in-hospital mortality and the mortality after 2 years is substantial.

1Department of Intensive Care and Emergency Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.

2Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

3National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands.

4Dutch National Poisons Information Center, University Medical Center, University of Utrecht, Utrecht, The Netherlands.

5Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands.

* See also p. 1563.

Dr. Brinkman is employed by National Intensive Care Evaluation (NICE) (foundation pays the department of medical informatics to process and analyze data for the registry). Dr. de Keizer is employed by NICE (foundation pays the department of medical informatics to process and analyze data for the registry). Dr. de Lange served as a board member of the NICE foundation and received support for the development of educational presentations (lecturing fees by congress organizations). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins