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Increased need for interventions predicts mortality in the critically ill
Author(s) -
Efendijev I.,
Raj R.,
Skrifvars M. B.,
Hoppu S.,
Reinikainen M.
Publication year - 2016
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12809
Subject(s) - medicine , intensive care unit , logistic regression , observational study , severity of illness , intensive care , multivariate analysis , emergency medicine , pediatrics , intensive care medicine
The aim of this study was to determine the association of early treatment intensity with hospital mortality of intensive care unit ( ICU ) patients. Methods We performed an observational study based on a national ICU registry. We included adult patients treated in Finnish ICU s between 2003 and 2013 with the length of ICU stay of more than 3 days. We measured treatment intensity with the Therapeutic Intervention Scoring System ( TISS ‐76). We assessed mean and daily TISS scores. To define the change in treatment intensity during the first days in the ICU , we calculated the difference between the TISS score on day 3 and the score on day 1 (Δ TISS ). We used multivariate logistic regression to adjust for baseline differences and continuous net reclassification improvement ( NRI ) to determine the impact of adding TISS data to the baseline prediction model on its prognostic performance. Results We identified 42,493 patients eligible for the study. For 71% of the patients, Δ TISS was ≤ 0 and crude hospital mortality was 18%. Δ TISS > 0 was observed for 29% of the patients, with a hospital mortality of 23%. When compared to the group Δ TISS ≤ 0, the category Δ TISS > 0 was independently associated with substantially increased mortality. Adding TISS data to the prediction model resulted in the improvement of prognostic performance particularly in the patients with the lowest initial baseline risk. Conclusions Early increase in TISS scores was associated with increased risk of death, especially in patients with a lower initial severity of illness.