Effects of Sepsis on Morbidity and Mortality in Critically Ill Patients 2 Years After Intensive Care Unit Discharge.

BACKGROUND: Morbidity and mortality after discharge from an intensive care unit appear to be higher in patients with sepsis than in patients without sepsis. OBJECTIVE: To evaluate morbidity and mortality in patients with and without sepsis within 2 years after intensive care unit discharge. METHODS: A prospective cohort study was conducted in 2 intensive care units. Patients who stayed in the intensive care unit longer than 24 hours were followed up for 2 years after discharge. Morbidity was assessed by using the Karnofsky scale, the Lawton instrumental activities of daily living scale, presence of pain, and readmissions. RESULTS: During the study, 74.7% of patients (859 of 1150; 242 with sepsis, 617 without sepsis) were discharged from the intensive care unit. Compared with patients without sepsis, patients with sepsis had higher mortality during follow-up (57.4% vs 34.2%; P < .001) and were 1.34 times as likely to die (per Cox regression). More patients with sepsis had pain (48.5% vs 35.2%, P = .003) and read-missions (65.5% vs 55.0%, P = .02). Patients with sepsis had a greater degree of functional loss, adjusted for confounding factors (mean [SD] change in Lawton scale score from intensive care unit admission to 2 years after intensive care unit discharge, 4.0 [8.0] vs 3.4 [8.2]; P = .31). CONCLUSION: Compared with patients without sepsis, those with sepsis have higher mortality in the intensive care unit and have more pain, hospital readmissions, and functional decline within 2 years after discharge.

Corrigendum to "Public versus Private Healthcare Systems following Discharge from the ICU: A Propensity Score-Matched Comparison of Outcomes".

[This corrects the article DOI: 10.1155/2016/6568531.].

Public versus Private Healthcare Systems following Discharge from the ICU: A Propensity Score-Matched Comparison of Outcomes.

Purpose. The long-term outcomes of patients after discharge from tertiary ICUs as they relate to the public versus private healthcare systems in Brazil have not yet been evaluated. Materials and Methods. A multicenter prospective cohort study was conducted to compare the all-cause mortality and the physical functional status (PFS) 24 months after discharge from the ICU between adult patients treated in the public and private healthcare systems. A propensity score- (PS-) matched comparison of all causes of mortality and PFS 24 months after discharge from the ICU was performed. Results. In total, 928 patients were discharged from the ICU including 172 (18.6%) patients in the public and 756 (81.4%) patients in the private healthcare system. The results of the PS-matched comparison of all-cause mortality revealed higher mortality rates among the patients of the public healthcare system compared to those of the private healthcare system (47.3% versus 27.6%, P = 0.003). The comparison of the PS-matched Karnofsky performance and Lawton activities of daily living scores between the ICU survivors of the public and private healthcare systems revealed no significant differences. Conclusions. The patients of private healthcare system exhibited significantly greater survival rates than the patients of the public healthcare system with similar PFS following ICU discharge.

Patients admitted to the ICU for acute exacerbation of COPD: two-year mortality and functional status.

OBJECTIVE: To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. METHODS: A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). RESULTS: The sample comprised 231 patients. In-hospital mortality was 37.7%, and two-year post-discharge mortality was 30.3%. Of the 74 survivors, 66 were interviewed (89%). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8% of the patients. Of the 66 interviewees, 57 (86.3%) lived at home, 58 (87.8%) were self-sufficient, 12 (18.1%) required oxygen therapy, and 4 (6.1%) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. CONCLUSIONS: In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficient.

Mortality assessment and quality of life two years after discharge from the ICU: preliminary data from a prospective cohort. / Avaliação da mortalidade e qualidade de vida dois anos após a alta do CTI: dados preliminares de uma coorte prospectiva.

OBJECTIVES: To evaluate mortality and long term quality of life of patients who were discharged from the intensive care unit. METHODS: A prospective cohort, in which all the admitted patients in a intensive care unit (ICU) during 6 months were evaluated and interviewed by telephone after two years of discharge, aiming the completion of two quality of live scales: Karnofsky scale and activities of daily living (ADL) scale. RESULTS: From a total of 380 patients, 100 (26.5%) individuals were alive at the time of interview, 94% living in their homes and 90% without the need for family or specialized care. There was a significant reduction in quality of life of the survivors (Karnofsky pre-ICU = 90±10 vs. Karnofsky after two years = 79±11; p<0.05), although maintaining their functional capacity (ADL pre-ICU = 28±4 vs. ADL after two years = 25±8; p=0.09). This drop in the quality of life occurred mainly to patients who suffered stroke (Karnofsky pre-ICU = 88±7 vs. Karnofsky after two years = 60±15; p<0. 01). CONCLUSION: These preliminary data suggest that the performance of patients after two years of the intensive care discharge is preserved, since they retain the ability to perform self care, except in those with brain damage which shows an inferior quality of life.

Profile and long-term prognosis of glucose tight control in intensive care unit - patients: a cohort study. / Perfil e prognóstico a longo prazo dos pacientes que recebem terapia insulínica em unidades de terapia intensiva clínico-cirúrgica: estudo de coorte.

OBJECTIVES: Stress-induced hyperglycemia is frequent in critically ill patients and has been associated with increased mortality and morbidity (both in diabetic and non-diabetic patients). This study objective was to evaluate the profile and long-term prognosis of critically ill patients undergoing tight glucose-control. METHODS: Prospective cohort. All patients admitted to the intensive care unit over 1-year were enrolled. We analyzed demographic data, therapeutic intervention, and short- (during the stay) and long-term (2 years after discharge) mortality. The patients were categorized in 2 groups: tight glucose control and non-tight glucose-control, based on the unit staff decision. RESULTS: From the 603 enrolled patients, 102 (16.9%) underwent tight control (glucose <150 mg/dL) while 501 patients (83.1%) non-tight control. Patients in the TGC-group were more severely ill than those in the non-tight control group [APACHE II score (14 ± 3 versus 11 ± 4, P=0.04), SOFA (4.9 ± 3.2 versus 3.5 ± 3.4, P<0.001) and TISS-24h (25.7 ± 6.9 versus 21.1 ± 7.2, P< 0.001)]. The tight control group patients also had worse prognosis: [acute renal failure (51% versus 18.5%, P<0.001), critical illness neuropathy (16.7% versus 5.6%, P<0.001)] and increased mortality (during the ICU-stay [60.7% versus 17.7%, P<0.001] and within 2-years of the discharge [77.5% versus 23.4%; P<0.001]). CONCLUSION: Critically ill patients needing tight glucose control during the unit stay have more severe disease and have worse short and long-term prognosis.

Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI / Patients admitted to the ICU for acute exacerbation of COPD: two-year mortality and functional status

OBJETIVO: Determinar a taxa de mortalidade de pacientes com DPOC e avaliar o estado funcional dos sobreviventes dois anos após a alta da UTI. MÉTODOS: Estudo de coorte prospectiva realizada nas UTIs de dois hospitais na cidade de Porto Alegre (RS) com pacientes com exacerbação aguda de DPOC e internados em UTI entre julho de 2005 e julho de 2006. Dois anos após a alta, os sobreviventes foram entrevistados via telefone. Os dados obtidos foram utilizados na determinação dos escores da escala de Karnofsky e de uma escala de atividades de vida diária (AVD). RESULTADOS: Foram incluídos 231 pacientes. A mortalidade hospitalar foi de 37,7 por cento e a mortalidade extra-hospitalar foi de 30,3 por cento. Dos 74 sobreviventes, foram entrevistados 66 (89 por cento). A média de idade dos pacientes no momento da internação na UTI era de 74 ± 10 anos e a do escore Acute Physiology and Chronic Health Evaluation II era de 18 ± 7. Tinham duas ou mais comorbidades 87,8 por cento dos pacientes. Dos 66 entrevistados, 57 (86,3 por cento) viviam em suas casas, 58 (87,8 por cento) eram capazes de realizar seu autocuidado, 12 (18,1 por cento) utilizavam oxigenoterapia, e 4 (6,1 por cento) necessitavam suporte ventilatório. Houve uma significante redução na qualidade de vida e na autonomia, segundo os escores da escala de Karnofsky (85 ± 9 vs. 79 ± 11; p = 0,03) e de AVD (29 ± 5 vs. 25 ± 7; p = 0,01), respectivamente. CONCLUSÕES: A mortalidade desta amostra de pacientes foi muito elevada nos primeiros dois anos. Embora houvesse evidente redução do estado funcional dos sobreviventes, os mesmos preservaram a capacidade de realizar seu autocuidado.

OBJECTIVE: To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. METHODS: A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). RESULTS: The sample comprised 231 patients. In-hospital mortality was 37.7 percent, and two-year post-discharge mortality was 30.3 percent. Of the 74 survivors, 66 were interviewed (89 percent). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8 percent of the patients. Of the 66 interviewees, 57 (86.3 percent) lived at home, 58 (87.8 percent) were self-sufficient, 12 (18.1 percent) required oxygen therapy, and 4 (6.1 percent) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. CONCLUSIONS: In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficient.

Avaliação da mortalidade e qualidade de vida dois anos após a alta do CTI: dados preliminares de uma coorte prospectiva / Mortality assessment and quality of life two years after discharge from the ICU: preliminary data from a prospective cohort

OBJETIVOS: Avaliar a mortalidade e qualidade de vida dos pacientes que receberam alta do centro de tratamento intensivo a longo prazo. MÉTODOS: Coorte prospectiva em que foram avaliados todos os pacientes que internaram em um centro de tratamento intensivo durante 6 meses e entrevistados, via telefone, após dois anos da alta do centro de tratamento intensivo, visando o preenchimento de duas escalas de qualidade de vida: escala de Karnofsky e escala de atividades de vida diária (ADL). RESULTADOS: De um total de 380 pacientes, 100 (26,5 por cento) indivíduos estavam vivos na época da entrevista, 94 por cento vivendo em suas casas e 90 por cento sem necessidade de cuidado familiar ou especializado. Houve uma redução significativa na qualidade de vida dos sobreviventes (Karnofsky pré-CTI = 90 ±10 vs. Karnofsky após dois anos = 79±11; p<0,05), porém com manutenção da sua capacidade funcional (ADL pré-CTI = 28±4 vs. ADL após dois anos = 25±8; p=0,09). Esta queda na qualidade de vida deveu-se principalmente aos pacientes que sofreram acidente vascular encefálico (Karnofsky pré-CTI = 88±7 vs. Karnofsky após dois anos = 60±15; p<0,01). CONCLUSÃO: Estes dados preliminares sugerem que o desempenho dos pacientes após dois anos da alta do centro de tratamento intensivo é preservado, pois os mesmos mantêm a capacidade de realizar auto cuidado, exceto naqueles com danos cerebrais, os quais pioram muito a sua qualidade de vida.

OBJECTIVES: To evaluate mortality and long term quality of life of patients who were discharged from the intensive care unit. METHODS: A prospective cohort, in which all the admitted patients in a intensive care unit (ICU) during 6 months were evaluated and interviewed by telephone after two years of discharge, aiming the completion of two quality of live scales: Karnofsky scale and activities of daily living (ADL) scale. RESULTS: From a total of 380 patients, 100 (26.5 percent) individuals were alive at the time of interview, 94 percent living in their homes and 90 percent without the need for family or specialized care. There was a significant reduction in quality of life of the survivors (Karnofsky pre-ICU = 90±10 vs. Karnofsky after two years = 79±11; p<0.05), although maintaining their functional capacity (ADL pre-ICU = 28±4 vs. ADL after two years = 25±8; p=0.09). This drop in the quality of life occurred mainly to patients who suffered stroke (Karnofsky pre-ICU = 88±7 vs. Karnofsky after two years = 60±15; p<0. 01). CONCLUSION: These preliminary data suggest that the performance of patients after two years of the intensive care discharge is preserved, since they retain the ability to perform self care, except in those with brain damage which shows an inferior quality of life.

Perfil e prognóstico a longo prazo dos pacientes que recebem terapia insulínica em unidades de terapia intensiva clínico-cirúrgica: estudo de coorte / Profile and long-term prognosis of glucose tight control in intensive care unit - patients: a cohort study

OBJETIVOS: Hiperglicemia induzida por estresse ocorre com freqüência em pacientes criticamente doentes e tem sido associada a aumento de mortalidade e morbidade tanto em pacientes diabéticos, quanto em não diabéticos. O objetivo deste estudo foi avaliar o perfil e prognóstico a longo prazo dos pacientes críticos que recebem terapia insulínica contínua na unidade de terapia intensiva. MÉTODOS: Coorte prospectiva, em que foram estudados os pacientes internados na unidade de terapia intensiva no período de 1 ano. Foram analisadas variáveis demográficas, escores de gravidade e o prognóstico a curto na unidade de terapia intensiva, e a longo prazo (2 anos da alta da unidade de terapia intensiva). Os pacientes foram classificados em 2 grupos: pacientes que receberam terapia insulínica contínua para controle glicêmico indicada pela equipe da unidade de terapia intensiva e pacientes que não receberam terapia insulínica. RESULTADOS: Dos 603 pacientes incluídos no estudo, 102 (16,9 por cento) receberam terapia insulínica contínua, objetivando níveis glicêmicos <150 mg/dL e 501 pacientes (83,1 por cento) não receberam insulina contínua. Os pacientes que necessitaram terapia insulínica contínua eram mais graves que os do grupo não necessitou de terapia insulínica: escore APACHE II (14 ±3 versus 11 ±4; p =0,04), escore SOFA (4,9 ±3,2 versus 3,5 ±3,4; p <0,001) e TISS das 24h (25,7 ±6,9 versus 21,1 ±7,2; p <0,001). Os pacientes do grupo que recebeu terapia insulínica contínua tiveram também pior prognóstico: insuficiência renal aguda (51 por cento versus 18,5 por cento; p <0,001), polineuropatia da doença crítica (16,7 por cento versus 5,6 por cento; p <0,001)] e maior mortalidade [na unidade de terapia intensiva (60,7 por cento versus 17,7 por cento; p <0,001) e 2 anos após a alta da unidade de terapia intensiva (77,5 por cento versus 23,4 por cento; p <0,001). CONCLUSÃO: A necessidade de controle glicêmico rigoroso através do uso de protocolos de ...

OBJECTIVES: Stress-induced hyperglycemia is frequent in critically ill patients and has been associated with increased mortality and morbidity (both in diabetic and non-diabetic patients). This study objective was to evaluate the profile and long-term prognosis of critically ill patients undergoing tight glucose-control. METHODS: Prospective cohort. All patients admitted to the intensive care unit over 1-year were enrolled. We analyzed demographic data, therapeutic intervention, and short- (during the stay) and long-term (2 years after discharge) mortality. The patients were categorized in 2 groups: tight glucose control and non-tight glucose-control, based on the unit staff decision. RESULTS: From the 603 enrolled patients, 102 (16.9 percent) underwent tight control (glucose <150 mg/dL) while 501 patients (83.1 percent) non-tight control. Patients in the TGC-group were more severely ill than those in the non-tight control group [APACHE II score (14 ± 3 versus 11 ± 4, P=0.04), SOFA (4.9 ± 3.2 versus 3.5 ± 3.4, P<0.001) and TISS-24h (25.7 ± 6.9 versus 21.1 ± 7.2, P< 0.001)]. The tight control group patients also had worse prognosis: [acute renal failure (51 percent versus 18.5 percent, P<0.001), critical illness neuropathy (16.7 percent versus 5.6 percent, P<0.001)] and increased mortality (during the ICU-stay [60.7 percent versus 17.7 percent, P<0.001] and within 2-years of the discharge [77.5 percent versus 23.4 percent; P<0.001]). CONCLUSION: Critically ill patients needing tight glucose control during the unit stay have more severe disease and have worse short and long-term prognosis.