Abstract
PurposeThe final decision for discharge from the intensive care unit (ICU) is uncertain because it is made according to various patient parameters; however, it should be made on an objective evaluation. Previous reports have been inconsistent and unreliable in predicting post-ICU mortality. To identify predictive factors associated with post-ICU mortality, we analyzed physiological and laboratory data at ICU discharge.MethodsPatients admitted to our ICU between September 2012 and August 2013 and staying for critical care>2 days were included. Sequential Organ Failure Assessment (SOFA) score; systemic inflammatory response syndrome score; white blood cell count; and serum C reactive protein, procalcitonin (PCT), interleukin-6 (IL-6), lactate, albumin, and hemoglobin levels were recorded. The primary end point was 90-day mortality after ICU discharge. Two hundred eighteen patients were enrolled (195 survivors, 23 non-survivors).ResultsNon-survivors presented a higher SOFA score and serum PCT, and IL-6 levels, as well as lower serum albumin and hemoglobin levels. Serum PCT, albumin, and SOFA score were associated with 90-day mortality in multiple logistic regression analysis. Hosmer-Lemeshow test showed chi-square value of 6.96, and P value of 0.54. The area under the curve (95% confidence interval) was 0.830 (0.771–0.890) for PCT, 0.688 (0.566–0.810) for albumin, 0.861 (0.796–0.927) for SOFA score, and increased to 0.913 (0.858–0.969) when these were combined. Serum PCT level at 0.57 ng/mL, serum albumin at 2.5 g/dL and SOFA score at 5.5 predict 90-day mortality, and high PCT, low albumin and high SOFA groups had significantly higher mortality. Serum PCT and SOFA score were significantly associated with survival days after ICU discharge in Cox regression analysis.ConclusionsSerum PCT level and SOFA score at ICU discharge predict post-ICU mortality and survival days after ICU discharge. The combination of these two and albumin level might enable accurate prediction.
Highlights
Admission to the intensive care unit (ICU) is considered when patients need intensive treatment and monitoring that cannot be provided outside of the ICU [1]
Non-survivors had a higher Sequential Organ Failure Assessment (SOFA) score (P,0.001) and serum PCT and IL-6 levels (P,0.001) and decreased serum albumin (P50.003) and hemoglobin levels (P50.004) at ICU discharge compared to survivors
The results indicate that non-survivors present a higher SOFA score, higher serum PCT and IL-6 levels, and lower serum albumin and hemoglobin levels at ICU discharge compared to survivors
Summary
Admission to the intensive care unit (ICU) is considered when patients need intensive treatment and monitoring that cannot be provided outside of the ICU [1]. Institutional and regional characteristics might affect ICU discharge criteria, critically ill patients are generally considered suitable for discharge from the ICU when their physiological status has stabilized and the need for ICU monitoring and care is no longer necessary [1]. In a critical care setting, the basis of the final decision for discharge is uncertain, because it is made according to various physiological variables and laboratory data. Persistent inflammation, immunosuppression, malnutrition, and catabolism are potentially associated with poor clinical outcome after discharge from the ICU [8]
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