Mortalidad tras el alta de la Unidad de Cuidados Intensivos y factores pronósticos relacionados en una cohorte de pacientes críticos con disfunción multiorgánica / Post-Intensive Care Unit mortality and related prognostic factors in a cohort of critically ill patients with multi-organ dysfunction

Fundamento y objetivo: Evaluar la mortalidad tras el alta de la Unidad de Cuidados Intensivos –post-UCI– (hospitalaria y seguimiento a un año) y los factores asociados. Pacientes y método: Diseño de cohortes en enfermos medicoquirúrgicos con síndrome de disfunción multiorgánica (SDMO) durante sus primeras 24h de ingreso. Se registraron antecedentes personales, situación basal, datos generales de ingreso en UCI, estancia hospitalaria y datos de supervivencia mediante contacto telefónico al año. Se evaluó la mortalidad en cualquier momento del seguimiento, relizando una regresión de Cox para valorar factores de mortalidad. Resultados: Se reclutaron 545 pacientes. En el total del período de estudio fallecieron 256 pacientes (52,9%); de los ingresados en UCI fallecieron el 29,5%, mientras que de los 384 enfermos que pasaron a planta falleció el 14,8%. De los 327 enfermos dados de alta hospitalaria se ha contactado con el 81,3% (266 pacientes), de los que han fallecido el 14,3%. Los factores relacionados con la muerte hospitalaria fueron la edad (odds ratio [OR] 1,04; intervalo de confianza del 95% [IC 95%] 1,02-1,06; p<0,01) y una situación basal funcional disminuida (OR 1,7; IC 95% 1,1-2,9; p<0,05). Las variables relacionadas con la mortalidad posthospitalaria fueron: una situación basal funcional disminuida (OR 2,42; IC 95% 1,23-4,75; p<0,01) y el reingreso tras el alta hospitalaria (OR 1,45; IC 95% 1,19-1,76; p<0,001). Conclusiones: Los pacientes ingresados por un SDMO medicoquirúrgico presentan una mortalidad al año de seguimiento del 52,9%. Los factores que más influyen en la mortalidad hospitalaria son la edad y una situación funcional basal disminuida, ambos factores no modificables. Tras el alta hospitalaria, la situación funcional basal disminuida sigue siendo transcendental, junto con el reingreso hospitalario (AU)

Background and objective: To assess the post-Intensive Care Unit (ICU) mortality (in-hospital and one year after hospital discharge) and the associated factors. Patients and method: Cohort design in medical-surgical patients with multi-organ dysfunction syndrome (MODS) during the first 24h of admission to ICU. We recorded the following data: personal background, functional general situation, general information about admission to ICU, hospital stay and contact by phone after one year of hospital discharge. We registered mortality at the follow-up at anytime. Cox regression was performed to evaluate mortality factors. Results: Five hundred and forty five patients were recruited. During the study period 256 patients (52.9%) died; out of them 29.5% in ICU; 14.8% of 384 patients transferred to the ward died. Of 327 discharged patients, 266 (81.3%) were contacted; 14.3% of those had died. In-hospital death-related factors were age (odds ratio [OR] 1.04; 95% confidence interval [95% CI] 1.02-1.06; P<.01) and a decreased functional general status (OR 1.7; 95% CI 1.1-2.9; P<.05). Post-hospitalisation mortality-related variables were: diminished functional general status (OR 2.42; 95% CI 1.23-4.75; P<.01) and readmission after discharge from hospital (1.45 OR; 95% CI 1.19-1.76; P<.001). Conclusions: Patients admitted for a medical-surgical MODS presented a mortality of 52.9% within one year. The factors influencing hospital mortality are age and a generally diminished functional status, both being not modifiable factors. After discharge, the decreased general functional status remained central along with the re-hospitalisation (AU)

[Post-Intensive Care Unit mortality and related prognostic factors in a cohort of critically ill patients with multi-organ dysfunction]. / Mortalidad tras el alta de la Unidad de Cuidados Intensivos y factores pronósticos relacionados en una cohorte de pacientes críticos con disfunción multiorgánica.

BACKGROUND AND OBJECTIVE: To assess the post-Intensive Care Unit (ICU) mortality (in-hospital and one year after hospital discharge) and the associated factors. PATIENTS AND METHOD: Cohort design in medical-surgical patients with multi-organ dysfunction syndrome (MODS) during the first 24h of admission to ICU. We recorded the following data: personal background, functional general situation, general information about admission to ICU, hospital stay and contact by phone after one year of hospital discharge. We registered mortality at the follow-up at anytime. Cox regression was performed to evaluate mortality factors. RESULTS: Five hundred and forty five patients were recruited. During the study period 256 patients (52.9%) died; out of them 29.5% in ICU; 14.8% of 384 patients transferred to the ward died. Of 327 discharged patients, 266 (81.3%) were contacted; 14.3% of those had died. In-hospital death-related factors were age (odds ratio [OR] 1.04; 95% confidence interval [95% CI] 1.02-1.06; P<.01) and a decreased functional general status (OR 1.7; 95% CI 1.1-2.9; P<.05). Post-hospitalisation mortality-related variables were: diminished functional general status (OR 2.42; 95% CI 1.23-4.75; P<.01) and readmission after discharge from hospital (1.45 OR; 95% CI 1.19-1.76; P<.001). CONCLUSIONS: Patients admitted for a medical-surgical MODS presented a mortality of 52.9% within one year. The factors influencing hospital mortality are age and a generally diminished functional status, both being not modifiable factors. After discharge, the decreased general functional status remained central along with the re-hospitalisation.