Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge

Objectives: Mortality after ICU discharge accounts for approx. 20-30 % of d eaths. We examined whether post-ICU discharge mortality is associated with the presence and severity of organ dysfunction/failure just before ICU disc harge. Patients and methods: The study used the database of the EURICUS-II study, with a total of 4621 patients, including 2958 discharged alive to the gener al wards (post-ICU mortality 8.6 %). Over a 4-month period we collected cli nical and demographic characteristics, including the Simplified Acute Physi ology Score (SAPS II), Nine Equivalents of Nursing Manpower Use Score, and Sequential Organ Failure Assessment (SOFA) score. Results: Those who died in the hospital after ICU discharge had a higher SA PS II score, were more frequently nonoperative, admitted from the ward, and had stayed longer in the ICU. Their degree of organ dysfunction/failure wa s higher (admission, maximum, and delta SOFA scores). They required more nu rsing workload resources while in the ICU. Both the amount of organ dysfunc tion/failure (especially cardiovascular, neurological, renal, and respirato ry) and the amount of nursing workload that they required on the day before discharge were higher. The presence of residual CNS and renal dysfunction/ failure were especially prognostic factors at ICU discharge. Multivariate a nalysis showed only predischarge organ dysfunction/failure to be important; thus the increased use of nursing workload resources before discharge prob ably reflects only the underlying organ dysfunction/failure. Conclusions: It is better to delay the discharge of a patient with organ dy sfunction/failure from the ICU, unless adequate monitoring and therapeutic resources are available in the ward.