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Vol. 48. Issue 2.
Pages 85-91 (February 2024)
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Vol. 48. Issue 2.
Pages 85-91 (February 2024)
Original article
Critically ill patients with high predicted mortality: Incidence and outcome
Pacientes en cuidados intensivos con alta mortalidad prevista: Incidencia y evolución
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André Oliveiraa, Tatiana Vieirab, Ana Rodriguesc, Núria Jorgeb, Luís Tavaresd, Laura Costae, José Artur Paivab,f,g, João Gonçalves Pereiraa,f,h,
Corresponding author
joaogpereira@fm.ul.pt

Corresponding author.
a Intensive Care Medicine Department, Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa Nº2, 2600-009 Vila Franca de Xira, Portugal
b Intensive Care Medicine Department, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
c Intensive Care Medicine Department, Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
d Intensive Care Medicine Department, Hospital Santo Espírito, Av. D. Manuel I, 9500-370 Ponta Delgada, Portugal
e Intensive Care Medicine Department, Hospital de Braga, R. das Comunidades Lusíadas 133, Braga, Portugal
f Grupo de Investigação e Desenvolvimento em Infeção e Sépsis (GISID), Rua Heróis de África, 381, Leça da Palmeira, 4450-681 Matosinhos, Portugal
g Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200 - 319 Porto, Portugal
h Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Table 1. Demographic characteristics.
Table 2. Patients’ mortality at the different time points after Intensive Care Unit admission.
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Abstract
Objective

As calculated by the severity scores, an unknown number of patients are admitted to the Intensive Care Unit (ICU) with a very high risk of death. Clinical studies have poorly addressed this population, and their prognosis is largely unknown.

Design

Post hoc analysis of a multicenter, cohort, longitudinal, observational, retrospective study (CIMbA).

Setting

Sixteen Portuguese multipurpose ICUs.

Patients

Patients with a Simplified Acute Physiology Score II (SAPS II) predicted hospital mortality above 80% on admission to the ICU (high-risk group); A comparison with the remaining patients was obtained.

Interventions

None.

Main Variables of Interest

Hospital, 30 days, 1 year mortality.

Results

We identified 4546 patients (59.9% male), 12.2% of the whole population. Their SAPS II predicted hospital mortality was 89.0±5.8%, whilst the observed mortality was lower, 61.0%. This group had higher mortality, both during the first 30 days (aHR 3.52 [95% CI 3.34–3.71]) and from day 31 to day 365 after ICU admission (aHR 1.14 [95%CI 1.04–1.26]), respectively. However, their hospital standardized mortality ratio was similar to the other patients (0.69 vs. 0.69, P=.92). At one year of follow-up, 30% of patients in the high-risk group were alive.

Conclusions

Roughly 12% of patients admitted to the ICU for more than 24h had a SAPS II score predicted mortality above 80%. Their hospital standardized mortality was similar to the less severe population and 30% were alive after one year of follow-up.

Keywords:
Epidemiology
Mortality
Intensive care
Follow up
SAPS II
High-risk
Resumen
Objetivo

Según las escalas de gravedad, un número indeterminado de pacientes ingresan en la Unidad de Cuidados Intensivos (UCI) con riesgo de muerte muy elevado. Este grupo ha sido poco abordado en los estudios clínicos y se desconoce en gran medida su pronóstico.

Diseño

Análisis post-hoc de estudio multicéntrico, de cohortes, longitudinal, observacional y retrospectivo (CIMbA).

Âmbito

Dieciséis UCI polivalentes portuguesas.

Pacientes

Pacientes con mortalidad hospitalaria prevista en el Simplified Acute Physiology Score II (SAPS II) superior al 80% nel ingreso en la UCI (grupo de alto riesgo); se compararon con los restantes.

Intervenciones

Ninguna.

Variables de interés principals

Mortalidad hospitalaria, a 30 días y 1 año.

Resultados

Se identificaron 4546 pacientes (59.9% hombres), 12.2% da población. La mortalidad hospitalaria estimada por lo SAPS II fue de 89.0±5.8%, aunque la observada fue inferior, 61.0%. Este grupo presentó mayor mortalidad, tanto durante los primeros 30 días (aHR 3.52 [IC 95%: 3.34–3.71]) y desde el día 31 hasta el día 365 después del ingreso en UCI (aHR 1.14 [IC 95%: 1.04–1.26]). Sin embargo, su índice de mortalidad hospitalaria estandarizada fue similar a los otros pacientes (0.69 vs. 0.69; P=.92). Al primer año de seguimiento, 30% de los pacientes de alto riesgo estaban vivos.

Conclusiones

Aproximadamente 12% de los pacientes ingresados en la UCI durante más de 24 horas tenían una mortalidad prevista por SAPS II superior al 80%. Su mortalidad hospitalaria estandarizada fue similar a la de la población menos grave y el 30% estaban vivos después de un año de seguimiento.

Palabras clave:
Epidemiología
Mortalidad
Cuidados intensivos
Seguimiento
SAPS II
Alto riesgo

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