Determinants of time to death in hospital in critically ill patients around the world

Abstract

Duration of hospital stay prior to death in critically ill patients is longer in older patients, surgical patients, and patients with infection. GNI is a major determinant of time to death in hospital in these patients. These observations may have important organizational and ethical implications.

Clinical relevance of copeptin plasma levels as a biomarker of disease severity and mortality in critically ill patients

“…Critical illness is a disease condition comprising a remarkable heterogeneity of underlying insults, such as shock, infections, metabolic derangements, burns, trauma, or severe blood loss. Despite these broad range of different initial causes, the body's response to such threats is relatively uniform, and severity of critical illness is determined by the degree of systemic inflammation and subsequent hemodynamic changes, the extent of biological stress, the resultant organ failure(s) and, ultimately, death . Circulating mediators of such core pathways could serve as prognostic biomarkers in critical care medicine …”

Focus on infection and sepsis 2017

“…Further efforts should be made from scientific societies to adequately provide resources for this population. A worldwide study demonstrated that gross national income (GNI) was a major determinant of time to death in hospital in ICU patients [7]. Not only GNI but also age (older patients), type of population (surgical), and infection increased the duration of hospital stay prior to death in critically ill patients.…”

Rebuttal From Dr Wunderink

“…However, the idea that pneumonia should be treatable drives a reluctance to shift to more comfort care measures in patients undergoing prolonged mechanical ventilation. 5 To expect new antibiotics, optimized pharmacokinetics/ pharmacodynamic protocols, and antibiotic stewardship to lead to improved outcomes for patients with HAP/ VAP meets Einstein's definition of insanity, paraphrased as "doing the same thing over and over again and expecting different results." Although each of these measures may have an important role in slowing the development of resistance, they are unlikely to decrease morbidity or mortality.…”