Authors: Ignacio MartinLoeches Richard G Wunderink Rahul Nanchal Jean Yves Lefrant Farhad Kapadia Yasser Sakr JeanLouis Vincent on behalf of the ICON Investigators
Publish Date: 2016/08/12
Volume: 42, Issue: 9, Pages: 1454-1460
Abstract
This was a predefined post hoc analysis of the Intensive Care Over Nations ICON database which included 10069 patients For this subanalysis we included only the 2062 60day inhospital nonsurvivors 223 among the 9258 patients with available hospital mortality and lengthofstay data We categorized these nonsurvivors into three groups according to the time of death after ICU admission early 5 days intermediate 6–28 days or late 28 daysTime to death in hospital was early in 1068 of the 2062 nonsurvivors 52 intermediate in 808 39 and late in 186 9 Patients who died early had higher severity scores and were more likely to require mechanical ventilation on ICU admission whereas those who died late were more likely to be older and to have had infection on ICU admission or during the ICU stay Multilevel analysis indicated a stepwise increase in the risk of late or intermediate deaths according to increasing GNI Patients admitted to ICUs in countries with high or uppermiddle GNI were more likely to die late than those admitted to countries with low/lowermiddle GNI odds ratio 95 confidence interval 478 194–1176 p 0001 and 164 110–245 p = 002 respectivelyDuration of hospital stay prior to death in critically ill patients is longer in older patients surgical patients and patients with infection GNI is a major determinant of time to death in hospital in these patients These observations may have important organizational and ethical implications
Keywords: