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November 3, 2006Critical CareOpen Access

Causes of death and determinants of outcome in critically ill patients

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Population

3,700 critically ill patients admitted to an adult intensive care unit in a tertiary, university teaching…

Design

Cohort

Follow-up

1 year

Key result

Central nervous system failure was the strongest independent risk factor for death in the intensive care unit, increasing mortality risk by 16-fold (RR 16.07) compared to patients without this failure.

Authors

VMViktoria D. MayrMDMartin W. DünserVGVeronika Greil

Discussion

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Overview

May warrant enhanced CNS surveillance in surgical ICU settings; leaves open impact of targeted interventions on survival.

Study Design

Type

Cohort (n=3,700)

Multicenter

No

Structured PICO

P
Population
3,700 critically ill patients admitted to an adult intensive care unit (ICU) in a tertiary, university teaching hospital in Austria. Mean age 59.2 years, 64.6% male. Primarily surgical patients (79.7%), with 45.4% admitted post-cardiac surgery.
O
Outcome
Causes of death and risk factors for death in the ICU, in the hospital after discharge from ICU, and within one year after ICU admissionhard clinical

Main Result

Effect estimate: RR 16.07 (95% CI 8.2-31.4)

Absolute Event Rate: 54.2% vs 7.7%

p-value: p=<0.001

In a primarily surgical critically ill population, acute refractory multiple organ dysfunction syndrome was the leading cause of ICU death, while malignant tumors and chronic cardiovascular disease were the main causes of death after ICU discharge.

Limitations

  • Single-centre study design precludes wide generalisation of results
  • High proportion of postoperative patients may not be comparable with medical or neurology patients
  • MODS score differentiates only between organ dysfunction and failure, potentially overestimating failing organs
  • ICD classification based on death certificates may be inaccurate
  • Important parameters like genetic variables were omitted from the statistical analysis
  • Pre-existent diseases were documented in a binary fashion only, not considering severity
  • uncontrolled study

Cite This Study

Mayr et al. (2006) conducted a cohort in Critical illness (n=3,700). Central nervous system failure vs. No central nervous system failure was evaluated on Death in the intensive care unit (RR 16.07, 95% CI 8.2-31.4, p=<0.001). Central nervous system failure was the strongest independent risk factor for death in the intensive care unit, increasing mortality risk by 16-fold (RR 16.07) compared to patients without this failure.

synapsesocial.com/papers/6a0aa7fdd1c62eabd7379362https://doi.org/10.1186/cc5086
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