Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*

Abstract

Objective Clear understanding of the long-term consequences of critical care survivorship is essential. We investigated the care process and individual factors associated with long-term mortality among ICU survivors and explored hospital use in this group. Design Population based data linkage study using the Secure Anonymised Information Linkage (SAIL) databank. Setting All ICUs between 2006-2013 in Wales, UK. Patients We identified 40,631 patients discharged alive from Welsh adult ICUs. Intervention none. Measurements and Main results Primary outcome was 365-day survival. The secondary outcomes were 30 and 90-day survival and hospital utilisation in the 365 days following ICU discharge. Kaplan-Meier curves were plotted to compare survival rates. Cox proportional hazards regression models were used to determine risk factors of mortality. 7,883 (19.4%) patients died during the 1-year follow-up period. In the multivariable Cox regression analysis, advanced age and comorbidities were significant determinants of long-term mortality. Expedited discharge due to ICU bed shortage was associated with higher risk. The rate of hospitalisation in the year prior to the critical care admission was 28 hospitalised days/1000 days, post critical care was 88 hospitalised days/1000 days for those who were still alive; and 57 hospitalised days/1000 days and 412 hospitalised days/1000 days for those who died by the end of the study, respectively. Conclusions One in five ICU survivors die within one year, with advanced age and comorbidity being significant predictors of outcome, leading to high resource use. Care process factors indicating high system stress were associated with increased risk. More detailed understanding is needed on the effects of the potentially modifiable factors to optimise service delivery and improve long-term outcomes of the critically ill.

Long‐term survival after intensive care: A retrospective cohort study

“…In our study, the unadjusted 1‐year survival of patients who survived >30 days from ICU admission was 89%. This is in agreement with multiple similar studies (Table ) . However, these results differ from the 1‐year survival of 79% described by Iribarren‐Diarasarri et al In their study, follow‐up was started at the time of ICU admission but not at hospital discharge as in our study.…”

“…According to the review article by Willliams et al, increasing age, comorbidities and health or functional status were associated with worse long‐term outcomes in most studies reviewed. Severity of critical illness was also associated with worse long‐term outcomes, but it is likely that comorbidities are more important for long‐term survival . This is supported by the findings of Keenan et al where ICU patients surviving their initial ICU admission had a similar long‐term survival as patients admitted to hospital but not to the ICU .…”

Long-term mortality and outcome in hospital survivors of septic shock, sepsis, and severe infections: The importance of aftercare

“…We used a univariate Cox regression to determine a crude hazard ratio (HR crude ) of patients with former septic shock, sepsis, and severe infections without organ dysfunction compared to their matched pairs. Pertinent confounders were determined in accordance to our baseline covariates with a standardized difference of more than 10% indicating an insufficient covariate balance and evidence from previous studies regarding prespecified risk factors [11,13,15]. Thereafter, we used a multivariate Cox regression analysis to determine an adjusted hazard ratio (HR adj ) with age, sex, Charlson Comorbidity index, degree of nursing care dependency, hospital length of stay, comorbid conditions, and Case Mix Index as covariates.…”

“…Furthermore, due to the progress in intensive care medicine the absolute number of survivors to hospital discharge increases and should be expected to increase further [1,2]. Accordingly, it appears prudent to assess beyond hospital discharge their long-term prognosis and medical burden [9][10][11].…”

“…This suggests that there is an enormous need for specific aftercare management programs, post-discharge treatment strategies, and rehabilitation concepts so as to deal with the long-term consequences. However, to our knowledge, large studies exploring a potential impact of post-discharge rehabilitation on long-term outcome of severe infections and especially sepsis are widely lacking [11,15].…”