Long-term prognosis for patients admitted to a medical intermediate care unit. / Langtidsprognose for pasienter innlagt i en medisinsk overvåkningsavdeling.

BACKGROUND: The intermediate care unit at Akershus University Hospital treats patients with incipient or manifest organ failure. Selecting patients who might benefit from treatment in an intermediate care unit is challenging. Few data are available on long-term survival of patients treated in medical intermediate care units and on how assumed favourable and unfavourable prognostic factors predict long-term survival in this population. MATERIAL AND METHOD: Comorbidity, reason for admission and whether an infection was a direct or contributory reason for the admission were prospectively registered for patients in the unit in 2014 and 2016. We registered mortality up to six years after the admission and conducted a logistic regression analysis with three-year survival as the outcome variable. RESULTS: Of the 2 170 included patients, 153 (7 %) died in the intermediate care unit. Of the 2 017 patients who were discharged alive from the intermediate care unit, 55 % were still alive three years later, including 28 % of older patients aged over 80 years and 23 % of patients with cancer. Age, malignancy, other comorbidity and infection were predictors of mortality. INTERPRETATION: Many patient groups in an intermediate care unit have a poor long-term prognosis. However, people older than 80 years, cancer patients or patients with another serious comorbidity may live long after their stay in an intermediate care unit, and the fact of belonging to these groups should not be an independent reason for withholding treatment.

Epidemiology and prognoses in a medical intermediate care unit. / Epidemiologi og prognoser i en medisinsk overvåkningsavdeling.

BACKGROUND: The purpose of medical intermediate care units is the observation and treatment of patients with incipient or manifest organ failure. We wished to obtain data on which conditions result in admission to these units and the prognosis for these patients. MATERIAL AND METHOD: All patients admitted to the medical intermediate care unit at Akershus University Hospital in 2014 were registered prospectively with reason for admission, period of hospitalisation, degree of severity, comorbidity, last place of hospitalisation prior to medical intermediate care and treatment limitations (do-not-resuscitate order and/or do-not-intubate order). Mortality in the hospital and one year after hospitalisation were registered retrospectively. Multiple regression analysis was performed with hospital mortality as the outcome variable. RESULTS: Altogether 1369 patient hospitalisations for 1118 unique patients were included. The most frequent reasons for admission were pneumonia, chronic obstructive pulmonary disease, sepsis, poisonings and hyponatraemia. The degree of severity of the condition for which patients were admitted corresponded to that reported by intensive care departments in Norwegian local hospitals. A total of 13 % died during their stay in hospital and a further 14 % in the course of one year. The highest mortality was for patients with severe infection, cardiac failure and restrictive/neuromuscular respiratory disorder. The degree of severity, age, infection, comorbidity and ward as admitting unit were predictors of mortality during the hospitalisation period. Risk-adjusted mortality ratio of 0.64 satisfied the quality objective for intensive care departments (<0.7). A total of 5.6 % of hospitalisations in the medical intermediate care unit entailed transfer to the intensive care ward. INTERPRETATION: The degree of severity of the condition for which patients were admitted was high, and the treatment outcomes judged upon expected mortality were good. Medical intermediate care units can relieve pressure on wards with seriously ill patients without taking up intensive care beds.