• Albert Nadjarian, Jessica LeClair, Taylor F Mahoney, Eric H Awtry, Jasvinder S Bhatia, Lisa B Caruso, Alexis Clay, David Greer, Karan S Hingorani, L F B Horta, Michel Ibrahim, Michael H Ieong, Thea James, Matthew H Kulke, Remington Lim, Robert C Lowe, James M Moses, Jaime Murphy, Ala Nozari, Anuj D Patel, Brent Silver, Arthur C Theodore, Ryan Shufei Wang, Ellen Weinstein, Stephen A Wilson, and Anna M Cervantes-Arslanian.
• Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA.
• Crit. Care Med. 2021 Oct 1; 49 (10): 173917481739-1748.

ObjectivesThe coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital.DesignWe applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals.SettingAn urban safety-net hospital ICU.PatientsAll adults hospitalized during April of 2015 and April 2019 identified through a clinical database search.InterventionsNone.Measurements And Main ResultsOf 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories.ConclusionsPatients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

30 keywords...

hide…