• 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, I... more nfectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP), and OUTCOMEREA Network. less
• 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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