Mortality Predictors and Associated Factors in Patients in the Intensive Care Unit: A Cross-Sectional Study

Abstract

Background. Mortality in the intensive care unit (ICU) has been associated to an array of risk factors. Identification of risk factors potentially contribute to predict and reduce mortality rates in the ICU. The objectives of the study were to determine the prevalence and the factors associated with the mortality and to analyze the survival. Method. A cross-sectional study conducted in two clinical and surgical ICU in the state of Sergipe, northeastern Brazil. We enrolled 316 patients with at least 48 h of hospitalization, minimum age of 18 years old, sedated or weaned, with RASS ≥ −3, between July 2017 and April 2018. We categorized data in (1) age and gender, (2) clinical condition, and (3) prevalence of delirium. Data from enrolled patients were collected from enrollment until death or ICU discharge. Patients’ outcomes were categorized in (1) death and (2) nondeath (discharge). Results. Twenty-one percent of participants died. Age (53 ± 17 years vs. 45 ± 18 years, p<0.01), electrolyte disturbance (30.3% vs 18.1%, p=0.029), glycemic index (33.3% vs 18.2%, p=0.008), tube feeding (83.3% vs 67.1%, p=0.01), mechanical ventilation (50% vs 35.7%, p=0.035), sedation with fentanyl (24.2 vs 13.6, p=0.035), use of insulin (33.8% vs 21.7%, p=0.042), and higher Charlson score (2.61 vs 2.17, p=0.041) were significantly associated with death on the adjusted model. However, the regression model indicated that patients admitted from the emergency (HR = 0.40, p=0.006) and glycemic index alterations (HR = 1.68, p=0.047) were associated with mortality. There was no statistically significant difference (p=0.540) in survival between patients with and without delirium, based on the survival analysis and length of hospitalization. Conclusion. The prevalence of death was 21%, and age, electrolyte disturbance, glycemic index, tube feeding, mechanical ventilation, sedation with fentanyl, use of insulin, and higher Charlson score were associated with mortality.

Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital

“… 1 Infections, presence of underlying disease, length of hospitalization, sedation, mechanic ventilation, use of vasopressors drugs, advanced age of the patient, and interventional procedures increase mortality. 2 The mean death rate of ICU noticed in the United States is between 8 and 19%, and annual deaths are reported as approximately 500,000 people. 1 In studies reported from our country, the ICU mortality rate was reported to be between 20.5 and 40.2%.…”

Tempo de permanência prolongado na emergência associado à delirium em idosos: revisão sistemática

“…Outrossim, a idade é um fator que precede o desenvolvimento das doenças crônicas como Alzheimer, cânceres, doenças neurodegenerativas e cardiovasculares, além da fragilidade, imobilidade e delirium que são associados à morbimortalidade, hospitalização e custos no sistema de saúde mundial (Oh et al, 2017;Parant, 1990). Delirium é um estado agudo confusional, frequente em idosos, caracterizado por início agudo, nível alterado de consciência, curso flutuante e distúrbios na orientação, memória, atenção, pensamento desorganizado e comportamento (Oh et al, 2017;Tchkonia et al, 2018), pode ser associado à doenças graves (Pinheiro et al, 2020), ou não, e a prevalência no departamento de emergência varia de 7 a 10%, em idosos (Átilla et al, 2014), porém apenas 16% a 35% dos casos são diagnosticados (Elie et al, 2000;Hustey & Meldon, 2002).…”

“…Este estado confusional é, também, um evento adverso, que repercute na qualidade de cuidado (Pinheiro et al, 2020), associado à piores desfechos (Schubert et al, 2018) Pacientes idosos com delirium possuem 1,5 maior risco de óbito (Smith & Meyfroidt, 2017) e duplicam o tempo de permanência no hospital, o que acarreta no dobro de horas de profissionais de saúde e dobram os custos totais da internação por paciente (Pinheiro et al, 2020).…”

Predicting in-hospital mortality for MIMIC-III patients: A nomogram combined with SOFA score

“…The intensive care unit (ICU) provides a continuous monitoring system for critically ill patients with potential for rehabilitation or life-threatening diseases and is committed to providing targeted monitoring and best care. [ 1 ] Due to the high fatality rate and expensive medical resources, the ICU has attracted extensive attention in the medical community. [ 2 ] To facilitate continuous monitoring of all patients and ensure that any deterioration of their condition is detected and corrected before it becomes a fatal disease, the ICU staff to patients ratio is often very high, which has been proven to improve results.…”