Risk factors for ICU mortality in critically ill patients

Background and Purpose:Advances in critical care medicine have increased th e chances of survival For patients with severe illness or trauma. However, stich patients consume a large proportion of medical resources. This Study sought risk factors for mortality that. have potential to be modified among patients treated in medical or surgical intensive care units (ICUs). Methods: This 6-month prospective observational-study was conducted in the medical and surgical ICUs of an 1,800-bed university hospital. All adult pa tients with an expected ICU stay of 48 hours or more were followed up regul arly until discharge from the ICUS, or for 10 weeks during their stay in IC Us. Results: Of 342 patients enrolled, 77 (22.5%) died during a median follow-u p period of 5 days (range, 2-70 days). Among a range of variables at the ti me of ICU entry I or developing during stay, in ICUs, 17 were associated wi th higher mortality rate Multivariate analysis using a logistic regression model demonstrated that the presence of systemic inflammatory response synd rome (SIRS) at the time of ICU entry (adjusted relative risk, ARR, 2.85; 95 % confidence interval, CI, 1.16-7.05), Acute Physiological and Chronic Heal th Evaluation (APACHE) II score on ICU Day 4 (AR.R 1.12 with increment of o ne score; 95% CI 1.01-1.24), Therapeutic Intervention Scoring System (TISS) score on Day 4 (ARR 1.13 with increment of one score; 95% CI 1.05-1.23), p arenteral nutrition (ARR 4.97, 95% CI 1.73-14.26), and nosocomial Candida i nfection (ARR 3.39, 95% CI 1.12-10.23) were independently associated with I CU mortality. Conclusions. In addition to SIRS and the APACHE-II and TISS scores, this St ud, found that nosocomial Candida infection and parenteral nutrition were i ndependently associated with mortality after control for admission conditio ns, severity of illness scores, and interventions.