Critical Care: ICU Management and Outcomes |

Mortality in the ICU: Who Dies Within the First 24 Hours? FREE TO VIEW

Krishna Siva Sai Kakkera; Aditya Chada; Kshitij Chatterjee; Clinton Colaco; corwin howard
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University of Arkansas for Medical Sciences, Little Rock, AR

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):292A. doi:10.1016/j.chest.2016.08.305
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SESSION TITLE: ICU Management and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 08:45 AM - 10:00 AM

PURPOSE: Despite many studies looking at ICU mortality, there is little data on those patients who die within 24-hours of ICU admission. The objective of the study was to characterize patients who died within the first 24 hours of ICU admission

METHODS: This was a retrospective study of patients who died within 24 hours of admission to a medical or surgical ICU at a tertiary care medical center over a period of one year June 2014 to May 2015. Primary outcome was mortality during the first 24 hours following ICU admission. Variables examined included patient demographics, modified SOFA score, baseline ECOG score, Code status/ CPR and selected laboratory values. All patients were managed by an in-house ICU team and a critical care attending physician on-site during day and available by phone overnight. Of particular interest was the time of admission (admission times were sorted into three groups, 8am to 4pm, 4pm to 12am and 12am to 8am based on shift change timings) and weekend vs non weekend admission.

RESULTS: During the study period there were a total of 5090 ICU admissions and 476 (9%) deaths in either the MICU or SICU. A total of 89 (18.9%) deaths were within 24 hours of admission to the ICU. Most patients (90%) who expired within the first 24 hours were non-surgical admissions. The primary ICU admission diagnosis was: hypotension 29%; primary CNS event (head injury, hemorrhage, or stroke) 25%; cardiac arrest/MI 20%; respiratory failure 10%; and trauma/postop 10%. A total of 45% of patients required CPR during the first 24 hours of which 60% had return of circulation. There was no relationship between 24-hour mortality and admission time, although there was a trend towards more early deaths on weekends. Patients who expired within the first 24 hours were older (~61% >55 years of age). Of the 89 patients; 20 had a SOFA score 8-11, 47 had a score of >13 and 22 had a score of < 8. Modified SOFA score was not a good predictor of mortality within the first 24 hours as 25% of patients had a score < 8. A total of 61 patients out of 89 had a lactate elevation > 2.5mmol/dl at the time of admission of which 39 had a lactate > 6mmol/dl. Approximately ~79% of patients had a baseline ECOG score of 2 or higher.

CONCLUSIONS: Deaths within the first 24 hours of ICU admission are common. Most of these patients are medical patients with hemodynamic instability with elevated serum lactate level or patients with a primary neurologic diagnosis. There was no relationship between time of ICU admission and early mortality.

CLINICAL IMPLICATIONS: Identification of patients at high risk of early death in the ICU may allow interventions directed at improving outcome in these high-risk patients.

DISCLOSURE: The following authors have nothing to disclose: Krishna Siva Sai Kakkera, Aditya Chada, Kshitij Chatterjee, Clinton Colaco, corwin howard

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