Risk Factors for 28-Day Mortality in a Surgical ICU: A Retrospective Analysis of 347 Cases

Abstract

Purpose Advances in surgical techniques and intensive care over the past decades have significantly reduced the mortality rates of critically ill surgical patients. However, evaluations of risk factors associated with mortality in surgical intensive care units (ICUs) are limited. The aim of this study was to analyze the independent risk factors for 28-day mortality of surgical ICU patients. Patients and Methods The clinical data of adult patients who were admitted to the surgical ICU in the First Affiliated Hospital of Xi’an Jiaotong University from June 2013 to June 2017 were collected. Univariate and multivariable logistic regression analyses were performed to examine risk factors associated with 28-day mortality. Results A total of 347 patients were included in this analysis. The overall 28-day mortality rate was 32.6%. The major causes of surgical ICU admission were gastrointestinal diseases (46.7%), infection (20.5%), trauma (8.9%), respiratory diseases (8.9%) and cardiovascular diseases (6.6%). The univariate analysis showed age, total bilirubin, prothrombin time, international normalized ratio, arterial lactate level, APACHE II and SOFA score at ICU admission were significantly associated with 28-day mortality. In the multivariate analysis, however, age [Odds Ratio (OR): 2.899, 95% CI: 1.427–5.890, P=0.003], hypertension [OR: 3.630, 95% CI: 1.545–8.531, P=0.003], platelet count [OR: 1.004, 95% CI: 1.001–1.007, P=0.015], arterial lactate level [OR: 1.186, 95% CI: 1.088–1.293, P<0.001] and SOFA score [OR: 1.289, 95% CI: 1.131–1.469, P<0.001] were identified as the independent risk factors for 28-day mortality of patients in the surgical ICU. Conclusion In patients admitted to the surgical ICU, age 65 and older, a high arterial lactate level and SOFA score at ICU admission were associated with increased 28-day mortality.

The magnitude of mortality and its determinants in Ethiopian adult intensive care units: A systematic review and meta-analysis

“…Our study result was comparable with study findings of Tanzania [ 7 ], Uganda [ 30 ], Nigeria [ 32 ], and Pakistan [ 55 ]. However, our findings were higher than reports from the United States of America, Ireland, Denmark, Scotland, China, and Thailand [ 9 , 29 , [56] , [57] , [58] , [59] , [60] ]. This notable disparity could be attributable to differences in the availability of resources in the ICU, including medications and medical equipment [ 61 ].…”

Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study

“…Our result is also higher than studies conducted in most high and middle-income countries, including Ireland, China, Brazil, Thailand, and South Africa ( 4 , 8 , 9 , 22 , 23 ). This discrepancy might have resulted from the shortage of essential medications and equipment, which could significantly affect survival from the SICU ( 24 , 25 ).…”

“…Our result is also higher than studies conducted in most high and middle-income countries, including Ireland, China, Brazil, Thailand, Creatinine (mg/dl), Median (IQR) 1.5 (1.0, 1.9) 0.6 (0.5, 0.9) 0.8 (0.6, 1.5) p, frequency; %, percentage; SpO2, peripheral oxygen saturation; mmHg, millimetre of mercury; WBC, white blood cell; SGOT, serum glutamic-oxaloacetic transaminase; SGT, serum glutamic pyruvic transaminase. and South Africa (4,8,9,22,23). This discrepancy might have resulted from the shortage of essential medications and equipment, which could significantly affect survival from the SICU (24, 25).…”

“…Age, length of stay, comorbidities, type of surgery, and condition on admission are the potential factors affecting the survival of surgical patients in the ICU ( 9 , 10 ). Apart from clinical factors, the unavailability of most essential and specialized components of ICU plays the lion’s share of role in the poor outcome in low-resource settings ( 11 ).…”

“…Apart from clinical factors, the unavailability of most essential and specialized components of ICU plays the lion’s share of role in the poor outcome in low-resource settings ( 11 ). Even though surgical patients admitted to the ICU have a variable disease process and an extensive range of severity of illness contributes to poor outcomes ( 9 , 10 ), studies regarding risk factors for mortality in the SICU are sparse in low-resource settings, including Ethiopia, which hinders practical adjustment to improve outcome. Studies conducted to determine predictors of mortality among surgical patients admitted to the SICU are limited to high-income countries and depend on staff availability, clinical and laboratory indices which are not readily available in low-resource settings where poor outcomes are reported despite the greater burden of critical diseases ( 11 ).…”