Assessment of risk factors for in-hospital mortality after intensive care unit discharge

Abstract

Charlson comorbidity score, CRP and tracheostomy predicted post-ICU in-hospital mortality.

Out-of-hours discharge from intensive care, in-hospital mortality and intensive care readmission rates: a systematic review and meta-analysis

“…Many studies that alone were not large enough to show a statistically significant effect (and could have been misinterpreted as there being no effect) contributed to our overall findings [9, 11, 16–18, 37–41]. One previous meta-analysis of the association between time of discharge from ICU and hospital mortality has been undertaken [46].…”

“…(2012) [16]Paper2008–2009PortugalSingle centreRetrospective cohort,Risk factors for post-ICU in-hospital mortalityMixed medical-surgical (including 7.6% cardiac surgery)None reported20:00–08:00High dependency unit or ward (proportions not stated)16/296(5.4)Azevedo et al (2015) [10]Paper2002–2009CanadaMulticentreRetrospective cohortIn-hospital mortality following out-of-hours ICU dischargeMixed medical-surgicalPatients with missing data ( n  = 399, 1.8%)19:00–07:59Not clearly stated3505/19,622 (17.9)Barker and Flint (2010) [39]Conference abstract2002–2009UKSingle centreRetrospective cohortIn-hospital mortality and readmission following out-of-hours ICU dischargeMixed medical-surgicalPatients with missing data ( n  = 16, 0.3%)16:00–07:59Not stated2565/5145 (49.9)Bramma et al (2012) [37]Conference abstractNot reported (3 year collection period)UKSingle CentreRetrospective cohortIn-hospital mortality following out-of-hours ICU dischargeMixed medical-surgicalPatients with missing data (n not reported)20:00–07:59 a or 17:00–07:59Not stated159/766(20.8)Edie et al (2015) [40]Conference abstract2007–2014UKSingle centreRetrospective cohortIn-hospital mortality following out-of-hours ICU dischargeMixed medical-surgicalPalliative care at discharge ( n  = 80, 2.5%)22:00–06:59Not stated478/3189(15)Gantner...…”

“…(2012) [16]Not reported b Not reported b Not reportedNot reported b Azevedo et al (2015) [10]57.5 (18.0) vs. 57.2 (17.9) p  = 0.3058.1 vs. 56.7 p  = 0.11Post-operative35.3% vs. 25.9% p  < 0.001APACHE a II:19.3 (7.4) vs. 20.1 (7.6) p  < 0.001Barker and Flint (2010) [39]Not reportedNot reportedNot reportedNot reportedBramma et al (2012) [37]51.9 (18.1) vs. 54.0 (17.7) p not reported48.9 vs. 50.9 p  = 0.65Not reportedAPACHE a II:15.8 (8.7) vs. 17.4 (8.0) p not reportedEdie et al (2015) [40]Not reportedNot reportedNot reportedNot reportedGantner et al (2014) [1]60.3 (19.3) vs. 59.4 (19.8) p  < 0.001Not reportedNot reportedAPACHE a III:46.5 (22.9) vs. 50.0 (25.3) vs p  < 0.001Goldfrad et al (2000) [2]58.2 (57.9, 58.5) vs. 57.5 (56.4, 58.7) p not reportedNot reportedNot reportedAPACHE a II:14.6 (14.5, 14.7) vs. 15.5 (15.1, 160.0)Gopal et al (2010) [38]Not reportedNot reportedNot reportedNot reportedHanane et al (2008) [11]62.7 (17.8) vs. 61.6 (18.0) p  = 0.23053.1 vs. 56.0 p  = 0.24Not reportedAPACHE a III:51.2 (23.6) vs. 53.2 (24) p  = 0.088Iapachino et al (2003) [17]Not reported b Not reportedNot reported b Not reported b Kramer et al (2013) [5]Not reported c Not reported c Not reported c …”

Out-of-hours discharge from intensive care, in-hospital mortality and intensive care readmission rates: a systematic review protocol

“…As out-of-hours discharge from an ICU could be considered a marker of premature discharge (the patient is discharged before they are ready because of bed pressures for example) [9] or because discharge out-of-hours may result in a relatively high-intensity patient arriving in area with less staff than in the daytime, resulting in decreased care [10], some authors have looked specifically at the effect of out-of-hours discharge from an ICU as a factor in this high post-ICU mortality rate [1, 2, 11]. There are also many studies which have retrospectively interrogated intensive care databases which may contain information on the effect of out-of-hours discharge [12, 13]. To the best of our knowledge, a systematic review of the association of out-of-hours discharge with in-hospital mortality, incorporating data from both of these two types of studies, has never been undertaken.…”

Impact of infection on admission and of the process of care on mortality of patients admitted to the Intensive Care Unit: the INFAUCI study

“…The careful assessment of patients' risk at the time of ICU discharge and the promotion of adequate sequential hospital care, namely a more prolonged ICU stay or an intense surveillance in a high-dependency unit [28], may benefit these patients. A potential role for C-reactive protein in identifying this high-risk population has been proposed [29,30].…”