• Hannah Wozniak, Alexis Tabah, Jan J De Waele, Jean-François Timsit, Niccolò Buetti, EUROBACT-2 Study Group, European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology, Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP), and OUTCOMEREA Network.
• Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland.
• Crit Care. 2024 Aug 31; 28 (1): 287287.

BackgroundThe decision to forgo life-sustaining treatment in intensive care units (ICUs) is influenced by ethical, cultural, and medical factors. This study focuses on a population of patients with hospital-acquired bloodstream infections (HABSI) to investigate the association between patient, pathogen, center and country-level factors and these decisions.MethodsWe analyzed data from the EUROBACT-2 study (June 2019-January 2021) from 265 centers worldwide, focusing on non-COVID-19 patients who died in the hospital or within 28 days after HABSI. We assessed whether death was preceded by a decision to forgo life-sustaining treatment, examining country, center, patient, and pathogen variables. To assess the association of each potentially important variable with the decision to forgo life-sustaining treatment, univariable mixed logistic regression models with a random center effect were performed.ResultsAmong 1589 non-COVID-19 patients, 519 (32.7%) died, with 191 (36.8%) following a decision to forgo life-sustaining treatment. Significant geographical differences were observed, with no reported decisions to forgo life-sustaining treatment in African countries and fewer in the Middle East compared to Western Europe, Australia, and Asia. Once a center effect was considered, only health expenditure (Odds ratio 1.79, 95%CI: 1.45-2.21, p < 0.01) and age (Odds ratio 1.02, 95%CI: 1.002-1.05, p = 0.03) were significantly associated with decisions to forgo life-sustaining treatment, while other patient and pathogen factors were not.ConclusionEconomic and regional disparities significantly impact end-of-life decision-making in ICUs. Global policies should consider these disparities to ensure equitable end-of-life care practices.© 2024. The Author(s).

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