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Table of Contents
LETTER TO THE EDITOR
Year : 2014  |  Volume : 4  |  Issue : 4  |  Page : 320-321

Long-term outcome factors associated with prolonged admission to the ICU


1 Intensive Care Unit, Universitary Hospital Insular of Gran Canaria, Las Palmas of Gran Cana, Spain
2 University of Las Palmas of Gran Canaria, Las Palmas of Gran Canaria, Spain

Date of Web Publication23-Dec-2014

Correspondence Address:
Luciano Santana-Cabrera
Avenida Marítima del Sur s/n., Las Palmas of Gran Canaria, Canary Islands-35016
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.147558

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How to cite this article:
Santana-Cabrera L, Torrent RL, Sánchez-Palacios M, Rodríguez-Escot C, Martín-Santana JD, Hernández JR. Long-term outcome factors associated with prolonged admission to the ICU. Int J Crit Illn Inj Sci 2014;4:320-1

How to cite this URL:
Santana-Cabrera L, Torrent RL, Sánchez-Palacios M, Rodríguez-Escot C, Martín-Santana JD, Hernández JR. Long-term outcome factors associated with prolonged admission to the ICU. Int J Crit Illn Inj Sci [serial online] 2014 [cited 2017 Oct 19];4:320-1. Available from: http://www.ijciis.org/text.asp?2014/4/4/320/147558

Sir,

The influence of prolonged intensive care unit (ICU) stay in prognosis has been studied by several authors and some found higher mortality among patients with prolonged stay compared to those who require a shorter stay in the ICU, although some authors found in their population a substantial number of these patients survive long-term. [1],[2] Some authors define prolonged length of stay of their patients to those that exceed the 95 th percentile of the overall stay, although most of the work referred to it when >14 days and other authors refer to stays >28 days. [2],[3],[4]

The objective of this study was to analyze the factors that can influence survival a year after hospital discharge associated with prolonged admission to the ICU.

We retrospectively reviewed data collected prospectively on patients admitted to the ICU from January 2004 to December 2010, with prolonged stay (>14 days), according to their survival 1 year later. During the study; 6,069 patients were admitted to the ICU. Seven hundred and seven (11.6%) stayed in ICU >14 days, and consumed a large proportion of ICU bed days (55.5%), 411 (58.13%) patients left hospital alive, and we only know their year survival to 297 patients (72.26%) [Table 1]. A logistic regression was performed to predict 1 year survival of patients with prolonged stay in ICU. From results shown in table, patients with prolonged ICU stay have a better prognosis after a year when they have a shorter stay in the ICU and lower Acute Physiology and Chronic Health Evaluation (APACHE) II at admission. With this regression we predict 100% survival in the group of patients who left hospital alive, but it is not possible to predict the survival of the group who died (0.0%). In statistical terms, this means that the model is able to predict correctly 92.0% of patients with prolonged stay admitted in ICU. [Figure 1] shows the receiver operating characteristic curve (ROC) of survival after a year, for the previous logistic regression model, for long stay patients in ICU. The area under the curve was 0.736.
Figure 1: Graph of ROC curve of survival after a year for long stay patients

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Table 1: Results of the logistic regression of patients' year survival with prolonged stay who left the hospital alive

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In conclusion, although the group of patients with prolonged stay is only a small percentage of ICU admissions, but they consume a large proportion of ICU bed days, comparable with data reported in the literature which range from 28 to 53% of available bed days. [5],[6] The factors that best define 1 year survival are length of stay in ICU and APACHE II at admission.

 
   References Top

1.
Wong DT, Gomez M, McGuire GP, Kavanagh B. Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit. Crit Care Med 1999;27:1319-24.  Back to cited text no. 1
    
2.
Heyland DK, Konopad E, Noseworthy TW, Johnston R, Gafni A. Is it ''worthwhile''to continue treating patients with a prolonged stay (>14 days) in the ICU? An economic evaluation. Chest 1998;114:192-8.  Back to cited text no. 2
    
3.
Arabi Y, Venkatesh S, Haddad S, Shimeri A, Malik S. A prospective study of prolonged stay in the intensive care unit: Predictors and impact on resource utilization. Int J Qual Health Care 2002;14:403-10.  Back to cited text no. 3
    
4.
Laupland KB, Kirkpatrick AW, Kortbeek JB, Zuege DJ. Long-term mortality outcome associated with prolonged admission to the ICU. Chest 2006;129:954-9.  Back to cited text no. 4
    
5.
Lipsett PA, Swoboda SM, Dickerson J, Ylitalo M, Gordon T, Breslow M, et al. Survival and functional outcome after prolonged intensive care unit stay. Ann Surg 2000;231:262-8.  Back to cited text no. 5
    
6.
Martin CM, Hill AD, Burns K, Chen LM. Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays. Crit Care Med 2005;33:1922-7.  Back to cited text no. 6
    


    Figures

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