• Crit Care Resusc · Jun 2024

    Prevalence and long-term outcomes of patients with life-limiting illness admitted to intensive care units in Australia and New Zealand.

    • Kate Wagner, Neil Orford, Sharyn Milnes, Paul Secombe, Steve Philpot, and David Pilcher.
    • Cabrini Hospital, Malvern, VIC, Australia.
    • Crit Care Resusc. 2024 Jun 1; 26 (2): 116122116-122.

    ObjectiveDetermine the prevalence and outcomes of patients with life-limiting illness (LLI) admitted to Australian and New Zealand Intensive Care Units (ICUs).Design Setting ParticipantsRetrospective registry-linked observational cohort study of all adults admitted to Australian and New Zealand ICUs from 1st January 2018 until 31st December 2020 (New Zealand) and 31st March 2022 (Australia), recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database.Main Outcome MeasuresThe primary outcome was 1-year mortality. Secondary outcomes included ICU and hospital mortality, ICU and hospital length of stay, and 4-year survival.ResultsA total of 566,260 patients were included, of whom 129,613 (22.9%) had one or more LLI. Mortality at one year was 28.1% in those with LLI and 10.4% in those without LLI (p < 0.001). Mortality in intensive care (6.8% v 3.4%, p < 0.001), hospital (11.8% v 5.0%, p < 0.001), and at two (36.6% v 14.1%, p < 0.001), three (43.7% v 17.7%, p < 0.001) and four (55.6% v 24.5%, p < 0.001) years were all higher in the cohort of patients with LLI. Patients with LLI had a longer ICU (1.9 [0.9, 3.7] v 1.6 [0.9, 2.9] days, p < 0.001) and hospital length of stay (8.8 [49,16.0] v 7.2 [3.9, 12.9] days, p < 0.001), and were more commonly readmitted to ICU during the same hospitalisation than patients without LLI (5.2% v 3.7%, p < 0.001). After multivariate analysis the LLI with the strongest adverse effect on survival was frailty (HR 2.08, 95% CI 2.03 to 2.12, p < 0.001), followed by the presence of metastatic cancer (HR 1.97, 95% CI 1.92 to 2.02, p < 0.001), and chronic liver disease (HR 1.65, 95% CI 1.65 to 1.71, p < 0.001).ConclusionPatients with LLI account for almost a quarter of ICU admissions in Australia and New Zealand, require prolonged ICU and hospital care, and have high mortality in subsequent years. This knowledge should be used to identify this vulnerable cohort of patients, and to ensure that treatment is aligned to each patient's values and realistic goals.Crown Copyright © 2024 Published by Elsevier B.V. on behalf of College of Intensive Care Medicine of Australia and New Zealand.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…