PurposeThis study compared the Charlson comorbidity index (CCI) information derived from chart review and administrative systems to assess the completeness and agreement between scores, evaluate the capacity to predict 30-day and 1-year mortality in intensive care unit (ICU) patients, and compare the predictive capacity with that of the Simplified Acute Physiology Score (SAPS) II model.Patients and methodsUsing data from 959 patients admitted to a general ICU in a Norwegian university hospital from 2007 to 2009, we compared the CCI score derived from chart review and administrative systems. Agreement was assessed using % agreement, kappa, and weighted kappa. The capacity to predict 30-day and 1-year mortality was assessed using logistic regression, model discrimination with the c-statistic, and calibration with a goodness-of-fit statistic.ResultsThe CCI was complete (n=959) when calculated from chart review, but less complete from administrative data (n=839). Agreement was good, with a weighted kappa of 0.667 (95% confidence interval: 0.596–0.714). The c-statistics for categorized CCI scores from charts and administrative data were similar in the model that included age, sex, and type of admission: 0.755 and 0.743 for 30-day mortality, respectively, and 0.783 and 0.775, respectively, for 1-year mortality. Goodness-of-fit statistics supported the model fit.ConclusionThe CCI scores from chart review and administrative data showed good agreement and predicted 30-day and 1-year mortality in ICU patients. CCI combined with age, sex, and type of admission predicted mortality almost as well as the physiology-based SAPS II.

The aim of the study was to review the epidemiology and prognosis of candidemia in a secondary hospital, and to examine the intra-hospital distribution of candidemia patients. Study design is a retrospective cohort study. Trough 2002–2012, 110 cases of candidemia were diagnosed, giving an incidence of 2, 6/100000 citizens/year. Overall prognosis of candidemia was dismal, with a 30 days case fatality rate of 49% and one year case fatality rate of 64%. Candidemia was a terminal event in 55% of 30 days non-survivors, defined as Candida blood cultures reported positive on the day of death or thereafter (39%), or treatment refrained due to hopeless short-term prognosis (16%). In terminal event candidemias, advanced or incurable cancer was present in 29%. Non-survivors at 30 days were 9 years (median) older than survivors. In 30 days survivors, candidemia was not recognised before discharge in 13% of cases. No treatment were given and no deaths or complications were observed in this group. Candidemia patients were grouped into 8 patient categories: Abdominal surgery (35%), urology (13%), other surgery (11%), pneumonia (13%), haematological malignancy (7%), intravenous drug abuse (4%), other medical (15%), and new-borns (3%). Candidemia was diagnosed while admitted in the ICU in 46% of patients. Urology related cases were all diagnosed in the general ward. Multiple surgical procedures were done in 60% of abdominal surgery patients. Antibiotics were administered prior to candidemia in 87% of patients, with median duration 17 (1–108) days. Neutropenia was less common than expected in patients with candidemia (8/105) and closely associated to haematological malignancy (6/8). Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.

Withholding or withdrawing treatment in the ICU was common. Medical and unscheduled surgical patients with limitations in treatment were older and more severely ill than patients without limitations. There is a potential for better documentation of the processes regarding withholding or withdrawing life-sustaining intensive care treatment.

The risk of developing myocardial infarction (MI) in connection with surgery and anaesthesia has been recognized for at least 75 years [19, 79, 93, 101]. Since then numerous reports have been published, some describing the incidence and characteristics of perioperative myocardial infarction (PMI), others the risk factors involved. To compare these publications is difficult because of the great span in years between various studies, and the variability in study conditions such as selection and size of population, the use of a retrospective or a prospective approach, variations in postoperative care, the method of diagnosis of PMI etc. These factors can at least partly explain the variability and even contradictions observed in results. In most of these studies statistical evaluation also leaves much to be desired. The questions are often multifactorial, without the appropriate tests being performed. Performing simple chi-squared tests on whether sex, age, type or duration of anaesthesia etc, influence the infarction rate, does not provide a correct picture. There is often some co-variation between many of these factors, such as duration of anaesthesia and type of surgery. Thus the papers should be evaluated critically and the effects of a single factor reported in a single paper should be interpreted with caution. Even more impressive, therefore, are the similarities in some of the results in spite of these differences in methodology, and certain trends appear in the literature that are important to the daily work of the anaesthetist. In this review we have concentrated on the epidemiological aspects of PMI and the risk factors that have practical consequences in the treatment of patients. Frontline research concerning the pathophysiology of myocardial ischaemia and infarction and possible effects of

The degree of severity of the condition for which patients were admitted was high, and the treatment outcomes judged upon expected mortality were good. Medical intermediate care units can relieve pressure on wards with seriously ill patients without taking up intensive care beds.