Abstract
Objective: The objective of the study is to determine factors that influence the outcome of long stay patients in a general intensive care unit (ICU) and/or high-dependency unit (HDU) in a New Zealand teaching hospital.
Setting: 10-bed general ICU and 4-bed surgical HDU in a 400-bed hospital.
Study type: Population based retrospective cohort study.
Methods: All patients with prolonged stay in a high resource area (>7 days in the ICU or >14 days in either the ICU or HDU) between 2000 and 2003 were reviewed. Demographic data, co-morbidities, diagnoses, clinical events, hospital and 1-year mortality data were obtained using available databases and patient records. Multiple logistic regression analysis was performed to identify which variables are associated with death among patients with a prolonged stay in a high-resource unit (ICU/HDU).
Results: 207 patients were included in the study. Twenty eight percent died before hospital discharge and 40% died within one year of their admission. Univariate analysis showed that increasing age, APACHE II score, admission post cardiac arrest, inpatient cardiac arrest, development of sepsis and requirement for renal support therapy were all risk factors for increased mortality. However, when adjusted for age, gender and APACHE II score the only risk factor strongly associated with death was having a cardiac arrest in the ICU.
Conclusions: Prolonged ICU and/or HDU stay is associated with a high mortality rate particularly in patients with advancing age and increasing severity of illness. In this study, only cardiac arrest after a prolonged stay in the ICU and/or HDU is a strong predictor of death independent of the age and the APACHE II score.
Geoffrey Paul Carden, Jonathan Wayne Graham, Stuart McLennan, Leo Anthony Celi
