Long‐term survival of intensive care and hospital patient cohorts compared with the general Australian population: a relative survival approach

Ghelani, Dhaval; Moran, John L.; Sloggett, Andy; Leeson, Richard J.; Peake, Sandra

doi:10.1111/j.1365-2753.2008.01030.x

Cited by 14 publications

(27 citation statements)

References 56 publications

(127 reference statements)

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“…Our results are consistent with previous studies that have shown excess late mortality after sepsis relative to the general population27 28 and that the late mortality is not explained by differences in health status before sepsis 1029 30 These past studies, however, have been inconclusive because of the substantial risk of residual confounding by incomplete capture of patients’ baseline health status.…”

Section: Discussionsupporting

confidence: 92%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

257

214

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Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.Deign Observational cohort study.Setting US Health and Retirement Study.Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals.Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

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Section: Discussionsupporting

confidence: 92%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

257

214

View full text Add to dashboard Cite

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“…Generally, the study populations included more males than females and the mean age of the cohorts ranged from 57 years to 63 years. Most of the studies measured severity of illness by using the APACHE II score 74,95,102,103,[107][108][109] and the mean score varied between 20.9 and 24.8 across the studies. Only limited information was reported on the proportion of patients with multiple organ dysfunction.…”

Section: Overview Of Included Studiesmentioning

confidence: 99%

“…The flow chart of studies included in the review is reported in Figure 38. Ten individual publications 74,93,95,102,103,[105][106][107][108][109] were identified from nine separate studies (with two publications coming from the same study).…”

Section: Studies Included In the Systematic Reviewmentioning

confidence: 99%

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An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis.

Soares

Welton²,

Harrison³

et al. 2012

Health Technol Assess

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects...

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“…The long-term survival of patients following discharge from ICU has been shown to be lower than that of the general population. 115 For years 2 to 9 post randomisation, we therefore used the relative survival rates from an observational study of long-term survival following ICU discharge in an Australian population. 115 This study presented relative survival data for four subsets: hospitalised patients with either sepsis or not and ICU patients with sepsis or no evidence of sepsis; each of these was presented separately by sex.…”

Section: Analysis and Reportingmentioning

confidence: 99%

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Lall

Hamilton

Young

et al. 2015

Health Technology Assessment

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BackgroundPatients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage.ObjectivesTo determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation.DesignA parallel, randomised, unblinded clinical trial.SettingUK intensive care units.ParticipantsMechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment.InterventionsTreatment arm HFOV using a Novalung R100®ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning.Control arm Conventional mechanical ventilation using the devices available in the participating centres.Main outcome measuresThe primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained.ResultsOne hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) −6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40;p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to society per QALY of £88,790 and an ICER for the cost to the NHS per QALY of £78,260.ConclusionsThe use of HFOV had no effect on 30-day mortality in adult patients undergoing mechanical ventilation for ARDS and no economic advantage. We suggest that further research into avoiding ventilator-induced lung injury should concentrate on ventilatory strategies other than HFOV.Trial registrationCurrent Controlled Trials ISRCTN10416500.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 23. See the NIHR Journals Library website for further project information.

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Long‐term survival of intensive care and hospital patient cohorts compared with the general Australian population: a relative survival approach

Abstract: Adverse long-term survival of intensive care and hospital patients was demonstrated. For hospital patients there was additional infection-related mortality risk, not evident for ICU patients after case mix control.

Cited by 14 publications

References 56 publications

Late mortality after sepsis: propensity matched cohort study

Late mortality after sepsis: propensity matched cohort study

An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis.

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

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