Determinants of time to death in hospital in critically ill patients around the world.

Martin-Loeches, Ignacio; Wunderink, Richard G; Nanchal, Rahul; Lefrant, Jean Yves; Kapadia, Farhad; Sakr, Yasser; Vincent, Jean-Louis; Jakob, Stephan (2016). Determinants of time to death in hospital in critically ill patients around the world. Intensive care medicine, 42(9), pp. 1454-1460. Springer 10.1007/s00134-016-4479-0

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PURPOSE

To investigate which factors influence time to death in hospital in critically ill patients worldwide, including the possible impact of gross national income (GNI).

METHODS

This was a pre-defined post hoc analysis of the Intensive Care Over Nations (ICON) database, which included 10,069 patients. For this sub-analysis, we included only the 2062 60-day in-hospital non-survivors (22.3 %) among the 9258 patients with available hospital mortality and length-of-stay data. We categorized these non-survivors into three groups according to the time of death after ICU admission: early (<5 days), intermediate (6-28 days) or late (>28 days).

RESULTS

Time to death in hospital was early in 1068 of the 2062 non-survivors (52 %), intermediate in 808 (39 %), and late in 186 (9 %). Patients who died early had higher severity scores and were more likely to require mechanical ventilation on ICU admission, whereas those who died late were more likely to be older and to have had infection on ICU admission or during the ICU stay. Multilevel analysis indicated a stepwise increase in the risk of late or intermediate deaths according to increasing GNI. Patients admitted to ICUs in countries with high or upper-middle GNI were more likely to die late than those admitted to countries with low/lower-middle GNI [odds ratio (95 % confidence interval) 4.78 (1.94-11.76), p < 0.001, and 1.64 (1.10-2.45), p = 0.02, respectively].

CONCLUSIONS

Duration of hospital stay prior to death in critically ill patients is longer in older patients, surgical patients, and patients with infection. GNI is a major determinant of time to death in hospital in these patients. These observations may have important organizational and ethical implications.

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