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Early and Late Mortality Following Discharge From the ICU

A Multicenter Prospective Cohort Study

Rosa, Regis G. PhD1,2,3; Falavigna, Maicon PhD2,4,5; Robinson, Caroline C. PhD2; Sanchez, Evelin C. RN2; Kochhann, Renata PhD2; Schneider, Daniel BSc2; Sganzerla, Daniel BSc2,5; Dietrich, Camila MSc2; Barbosa, Mirceli G. MSc2; de Souza, Denise MSc2; Rech, Gabriela S. BSc2; dos Santos, Rosa da R. RN2; da Silva, Alice P. RN2; Santos, Mariana M. MSc2; Dal Lago, Pedro PhD3; Sharshar, Tarek PhD6; Bozza, Fernando A. PhD7; Teixeira, Cassiano PhD1,3 for The Quality of Life After ICU Study Group Investigators and the BRICNet

doi: 10.1097/CCM.0000000000004024
Clinical Investigation: PDF Only
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Objectives: To identify the frequency, causes, and risk factors of early and late mortality among general adult patients discharged from ICUs.

Design: Multicenter, prospective cohort study.

Setting: ICUs of 10 tertiary hospitals in Brazil.

Patients: One-thousand five-hundred fifty-four adult ICU survivors with an ICU stay greater than 72 hours for medical and emergency surgical admissions or greater than 120 hours for elective surgical admissions.

Interventions: None.

Measurements and Main Results: The main outcomes were early (30 d) and late (31 to 365 d) mortality. Causes of death were extracted from death certificates and medical records. Twelve-month cumulative mortality was 28.2% (439 deaths). The frequency of early mortality was 7.9% (123 deaths), and the frequency of late mortality was 22.3% (316 deaths). Infections were the leading cause of death in both early (47.2%) and late (36.4%) periods. Multivariable analysis identified age greater than or equal to 65 years (hazard ratio, 1.65; p = 0.01), pre-ICU high comorbidity (hazard ratio, 1.59; p = 0.02), pre-ICU physical dependence (hazard ratio, 2.29; p < 0.001), risk of death at ICU admission (hazard ratio per 1% increase, 1.008; p = 0.03), ICU-acquired infections (hazard ratio, 2.25; p < 0.001), and ICU readmission (hazard ratio, 3.76; p < 0.001) as risk factors for early mortality. Age greater than or equal to 65 years (hazard ratio, 1.30; p = 0.03), pre-ICU high comorbidity (hazard ratio, 2.28; p < 0.001), pre-ICU physical dependence (hazard ratio, 2.00; p < 0.001), risk of death at ICU admission (hazard ratio per 1% increase, 1.010; p < 0.001), and ICU readmission (hazard ratios, 4.10, 4.17, and 1.82 for death between 31 and 60 days, 61 and 90 days, and greater than 90 days after ICU discharge, respectively; p < 0.001 for all comparisons) were associated with late mortality.

Conclusions: Infections are the main cause of death after ICU discharge. Older age, pre-ICU comorbidities, pre-ICU physical dependence, severity of illness at ICU admission, and ICU readmission are associated with increased risk of early and late mortality, while ICU-acquired infections are associated with increased risk of early mortality.

1Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil.

2Research Projects Office, HMV, Porto Alegre, Brazil.

3Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.

4Institute for Health Technology Assessment, Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.

5Postgraduate Program in Epidemiology, UFRGS, Porto Alegre, Brazil.

6General Intensive Care, Assistance Publique Hôpitaux of Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin-en-Yvelines, Paris, France.

7Department of Critical Care, Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Brazil.

The complete list of board members of The Quality of Life After ICU Study Group Investigators and BRICNet is provided in the electronic supplemental material (Supplemental Digital Content 1, http://links.lww.com/CCM/E958).

The study was carried out at Critical Care Department of Hospital Moinhos de Vento (Porto Alegre, Brazil), Critical Care Department of Hospital de Clínicas de Porto Alegre (Porto Alegre, Brazil), Critical Care Department of Hospital Santa Clara (Porto Alegre, Brazil), Critical Care Department of Pavilhão Pereira Filho (Porto Alegre, Brazil), Critical Care Department of Hospital Ernesto Dornelles (Porto Alegre, Brazil), Critical Care Department of Hospital Nossa Senhora da Conceição (Porto Alegre, Brazil), Critical Care Department of Hospital de Urgências de Goiânia (Goiânia, Brazil), Critical Care Department of Hospital Regional do Baixo Amazonas (Santarém, Brazil), Critical Care Department of Hospital Geral Clériston Andrade (Feira de Santana, Brazil), and Critical Care Department of Hospital do Coração (São Paulo, Brazil).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The present study was funded by the Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program. Drs. Rosa’s, Falavigna’s, Robinson’s, Sanchez’s, Kochhann’s, Schneider’s, Sganzerla’s, Dietrich’s, Barbosa’s, de Souza’s, Rech’s, and dos Santos’s institutions received funding from Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program. Dr Falavigna is manager partner of HTAnalyze, a consulting and training firm in health technology assessment topics. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: regis.rosa@hmv.org.br

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