Prevalence and long-term outcomes of patients with life-limiting illness admitted to intensive care units in Australia and New Zealand

The truism of ‘life limiting illness’ in ICU

“…Wagner and colleagues 5 also found that patients with organ failure LLIs, apart from chronic liver disease, had relatively better survival than those without LLI. Although this is an important finding, this finding should be interpreted cautiously as there is significant heterogeneity in the clinical presentations of such patients.…”

“…In this issue of Critical Care and Resuscitation , Wagner and colleagues investigated the prevalence and long-term outcomes of patients with life-limiting illnesses (LLI), defined as the presence of one or more APACHE-II or APACHE-III chronic organ insufficiency, frailty, or metastatic cancer, admitted to ICUs across Australia and New Zealand. 5 The authors found that more than one in five patients had at least one LLI, which were all independently and cumulatively associated with an increased likelihood of death. Although the authors found that patients with LLI were more likely to have treatment limitations at the time of ICU admission, these patients also had longer ICU and hospital stays.…”

“…Perhaps the most notable finding of this study was the worst outcomes observed for those patients with metastatic cancer and higher frailty degree, with particularly high mortality in patients exhibiting both factors. In Wagner and colleagues’ study cohort, 5 more than one-quarter of these patients with LLI had higher degrees of frailty (clinical frailty scale [CFS] score ≥6). This is in keeping with recent studies, which have found significantly worse health outcomes in these higher-frailty degree patients, 6 including a longer stay in ICU and hospital, non-home discharge, complications (delirium, pressure injuries), and mortality.…”

“…For example, a recent study demonstrated that only 50% of patients with frailty older than 80 years had early goals of care documentation within 72 h from admission to a medical ward. 11 Wagner and colleagues 5 have extended our understanding of this vulnerable patient cohort, serving as an important reminder for physicians to be more proactive in establishing timely goals of care documentation to avoid burdensome treatment, improve clinical outcomes, and decrease non-beneficial healthcare resource expenditure.…”

“…To conclude, Wagner and colleagues 5 have answered important questions in identifying the likely impact of LLI on critically ill patients, in both the short and long term. It is increasingly clear that a ‘one-size-fits-all’ approach to caring for patients with LLI in ICU is not appropriate.…”