J Korean Med Sci.  2017 Mar;32(3):528-533. 10.3346/jkms.2017.32.3.528.

Who Dies after ICU Discharge? Retrospective Analysis of Prognostic Factors for In-Hospital Mortality of ICU Survivors

• Lee J
• Cho YJ
• Kim SJ
• Yoon HI
• Park JS
• Lee CT
• Lee JH
• Lee YJ

• KMID: 2366652
• DOI: http://doi.org/10.3346/jkms.2017.32.3.528

Abstract

We investigated the causes of inpatient death after intensive care unit (ICU) discharge and determined predictors of in-hospital mortality in Korea. Using medical ICU registry data of Seoul National University Hospital, we performed a retrospective cohort study involving patients who were discharged alive from their first ICU admission with at least 24 hours of ICU length of stay (LOS). From January 2011 to August 2013, 723 patients were admitted to ICU and 383 patients were included. The estimated in-hospital mortality rate was 11.7% (45/383). The most common cause of death was respiratory failure (n = 25, 56%) followed by sepsis and cancer progression; the causes of hospital death and ICU admission were the same in 64% of all deaths; sudden unexpected deaths comprised about one-fifth of all deaths. In order to predict in-hospital mortality among ICU survivors, multivariate analysis identified presence of solid tumor (odds ratio [OR], 4.06; 95% confidence interval [CI], 2.01-8.2; P < 0.001), hematologic disease (OR, 4.75; 95% CI, 1.51-14.96; P = 0.013), Sequential Organ Failure Assessment (SOFA) score upon ICU admission (OR, 1.08; 95% CI, 0.99-1.17; P = 0.075), and hemoglobin (Hb) level (OR, 0.67; 95% CI, 0.52-0.86; P = 0.001) and platelet count (Plt) (OR, 0.99; 95% CI, 0.99-1.00; P = 0.033) upon ICU discharge as significant factors. In conclusion, a significant proportion of in-hospital mortality is predictable and those who die in hospital after ICU discharge tend to be severely-ill, with comorbidities of hematologic disease and solid tumor, and anemic and thrombocytopenic upon ICU discharge.

Keyword

Hospital Mortality; Intensive Care Unit; Risk Factors

MeSH Terms

Cause of Death
Cohort Studies
Comorbidity
Hematologic Diseases
Hospital Mortality*
Humans
Inpatients
Intensive Care Units
Korea
Length of Stay
Multivariate Analysis
Platelet Count
Respiratory Insufficiency
Retrospective Studies*
Risk Factors
Seoul
Sepsis
Survivors*

Figure

• 

  Fig. 1 Flow diagram of the study. MICU = medical intensive care unit, ICU = intensive care unit.

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