Outcome of Patients Admitted to Intensive Care Unit in a Quaternary Care Hospital
DOI:
https://doi.org/10.21649/akemu.v30i2.5451Keywords:
Audit,, , , intensive care unit, outcome, QuaternaryAbstract
Background: Quality Improvement (QI) in intensive care unit (ICU) is directly dependent upon the outcome of patients treated in ICU. Poor quality of care not only increases morbidity and mortality but also increase expenses.
Objective:: To conduct an audit on patients admitted to our ICU to determine their outcomes in terms of mortality and length of stay.
Methods: In this retrospective study, 330 patients who had been admitted to our intensive care unit (ICU) between December 1, 2022, and April 30, 2023, were reviewed. Patient’s demographic data was collected, and correlation was done between the length of stay in ICU, APACHE II score and mortality using t-test.
Results: Out of 330, there were 209 males (63.3%) and 121 (36.7%) females, with mean age of 41.9 + 15.3 years. There were 63 medical patients (19.1%) and 267 (80.9%) surgical patients, mainly liver and kidney transplant patients. Mean duration of ICU stay for survivors was 3.1 + 3.3 days vs 6.9 + 7.7 days for non-survivors (p-value 0.003) and overall mortality rate was 12.7%, mostly with end-stage liver or kidney diseases. In medical patients, the APACHE II score for survivors was 17.9 + 7.8 versus 24.5 + 9.6 in non-survivors (p-value 0.007), and for deceased medical patients it was 24.4 + 9.6 on admission and 31.8 + 8.9 after 48 hours of admission (p-value 0.001). While APACHE II score among deceased surgical patients was 19.5 + 3.7 on admission and 25.7 + 5.8 after 48 hours of admission (p-value 0.015). Most common cause of death was sepsis and multi-organ failure.
Conclusion: This audit presents the profile of patients admitted in ICU of a quaternary level hospital of Pakistan, mainly catering advanced liver and kidney diseases including transplant. The commonest cause of death was septic shock and multi-organ failure. Higher APACHE II scores and longer ICU stay are the predictors of mortality among our patients.
References
Mamdani M, Slutsky AS. Artificial intelligence in intensive care medicine. Intensive Care Med 2021; 47(1):147–149.DOI: 10.1007/s00134-020-06203-2.
Delahanty RJ, Kaufman D, Jones SS. Development and evaluation of an automated machine learning algorithm for in-hospital mortality risk adjustment among critical care patients. Crit. Care Med 2018;46(1):e481–e488. . DOI: 10.1097/CCM.0000000000003011.
Chelluri LP. Quality and performance improvement in critical care. Indian J Crit care Med 2008; 12 (2):67-76. DOI: 10.4103/0972-5229.42560.
Gaudry S, Messika J, Ricard JD, Guillo S, Pasquet B, Dubief E, et al. Patient-important outcomes in randomized controlled trials in critically ill patients: a systematic review. Annals of intensive care. 2017;7(1):1-1.. DOI 10.1186/s13613-017-0243-z.
Wittes J, Lakatos E, Probstfield J. Surrogate endpoints in clinical trials: cardiovascular diseases. Stat Med. 1989; 8(4):415–25. DOI: 10.1002/sim.4780080405
Pino C, Boutron I, Ravaud P. Outcomes in registered, ongoing randomized controlled trials of patient education. PLoS ONE. 2012;7(8):e42934;1-5. . DOI: org/10.1371/journal.pone.0042934
Gandhi GY, Murad MH, Fujiyoshi A, Mullan RJ, Flynn DN, Elamin MB, et al. Patient-important outcomes in registered diabetes trials. J Am Med Assoc. 2008; 299(21):2543–9. DOI: 10.1001/jama.299.21.2543
Tanaka T, Reichman TW, Olmos A, Akamatsu N, Mrzljak A, Spiro M, et al. When is the optimal time to discharge patients after liver transplantation with respect to short-term outcomes? A systematic review of the literature and expert panel recommendations. Clin Transplant 2022; 36(10):e14685. . DOI: 10.1111/ctr.14685.
Dugar S, Choudhary C, Duggal A. Sepsis and septic shock: Guideline-based management. Cleve Clin J Med 2020; 87 (1): 53-64; DOI: . DOI: 10.3949/ccjm.87a.18143
Baganate F, Beal EW, Tumin D, Azoulay D, Mumtaz K, Black SM, et al. Early Mortality after Liver Transplantation: Defining the Course and the Cause. Surgery 2018; 164(1):694–704. DOI:10.1016/j.surg.2018.04.039
Vincent JL, Marshall JC, Ñamendys-Silva SA, François B, Martín-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respri Med 2014; 2(5):380-6. DOI: 10.1016/S2213-2600(14)70061-X
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29(7):1303-10. DOI: 10.1097/00003246-200107000-00002.
Kim YN, Kim DH, Shin HS, Lee S, Lee N, Park MJ, et al. The risk factors for treatment-related mortality within first three months after kidney transplantation. Plos one. 2020;15(12):e0243586. DOI:10.1371/journal.pone.0243586
Polderman KH, Girbes AR, Thijs LG, Strack van Schijndel RJ. Accuracy and reliability of APACHE II scoring in two intensive care units: problems and pitfalls in the use of APACHE II and suggestions for improvement. Anaesthesia. 2001;56(1):47-50. DOI: 10.1046/j.1365-2044.2001.01763.x
Kumar S, Gattani SC, Baheti AH . Comparison of the performance of APACHE II, SOFA, and mNUTRIC scoring systems in critically ill patients: a 2-year cross-sectional study. Indian J Crit Care Med 2020;24(11):1057–61. DOI: 10.5005/jp-journals-10071-23549
Mumtaz H. Ejaz MK, Tayyab M, Vohra LI, Sapkota S, Hasan M, et al. APACHE scoring as an indicator of mortality rate in ICU patients: a cohort study. Ann. Med Surg 2023; 85(1):416–421. DOI:10.1097/MS9.0000000000000264.
Tian Y, Yao Y, Zhou J, et al. Dynamic APACHE II score to predict the outcome of intensive care unit patients. Front Med 2021;8(1):744907. DOI: 10.3389/fmed.2021.744907
Redline S, Baker-Goodwin S, Bakker JP, Epstein M, Hanes S, Hanson M, et al. Patient partnerships transforming sleep medicine research and clinical care: perspectives from the sleep apnea patient-centered outcomes network. J Clin Sleep Med. 2016; 12(7):1053–8. DOI: 10.5664/jcsm.5948
Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005;171(4):340–7. DOI: 10.1164/rccm.200406-763OC
Haftu H, Hailu T, Medhaniye A, G/tsadik T. Assessment of pattern and treatment outcome of patients admitted to pediatric intensive care unit, Ayder Referral Hospital, Tigray, Ethiopia, 2015. BMC research notes. 2018;11(1):1-6. DOI: 10.1186/s13104-018-3432-4.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Annals of King Edward Medical University
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments publications@kemu.edu.pk