Comorbidity and survival after admission to the intensive care unit: a population-based study of 41,230 patients

Simpson, A., Puxty, K. , McLoone, P. , Quasim, T. , Sloan, B. and Morrison, D. (2021) Comorbidity and survival after admission to the intensive care unit: a population-based study of 41,230 patients. Journal of the Intensive Care Society, 22(21), pp. 143-151. (doi: 10.1177/1751143720914229)

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Abstract

Purpose: To describe the relationship between comorbidities and survival following admission to the intensive care unit. Methods: Retrospective observational study using several linked routinely collected databases from 16 general intensive care units between 2002 and 2011. Comorbidities identified from hospitalisation in the five years prior to intensive care unit admission. Odds ratios for survival in intensive care unit, hospital and at 30 days, 180 days and 12 months after intensive care unit admission derived from multiple logistic regression models. Results: There were 41,230 admissions to intensive care units between 2002 and 2011. Forty-one percent had at least one comorbidity – 24% had one, 17% had more than one. Patients with comorbidities were significantly older, had higher Acute Physiology and Chronic Health Evaluation II scores and were more likely to have received elective rather than emergency surgery compared with those without comorbidities. After excluding elective hospitalisations, intensive care unit and hospital mortality for the cohort were 24% and 29%, respectively. Asthma (odds ratio 0.79, 95% confidence interval 0.63–0.99) and solid tumours (odds ratio 0.74, 0.67–0.83) were associated with lower odds of intensive care unit mortality than no comorbidity. Intensive care unit mortality was raised for liver disease (odds ratio 2.98, 2.43–3.65), cirrhosis (odds ratio 2.61, 1.9–3.61), haematological malignancy (odds ratio 2.29, 1.85–2.83), chronic ischaemic heart disease (odds ratio 1.53, 1.19–1.98), heart failure (odds ratio 1.79, 1.35–2.39) and rheumatological disease (odds ratio 1.53, 1.18–1.98). Conclusions: Comorbidities affect two-fifths of intensive care unit admission and have highly variable effects on subsequent outcomes. Information on the differential effects of comorbidities will be helpful in making better decisions about intensive care unit support and understanding outcomes beyond surviving intensive care unit.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quasim, Professor Tara and McLoone, Mr Philip and Puxty, Dr Kathryn and Morrison, Dr David and Sloan, Mr William
Authors: Simpson, A., Puxty, K., McLoone, P., Quasim, T., Sloan, B., and Morrison, D.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of the Intensive Care Society
Publisher:SAGE Publications
ISSN:1751-1437
ISSN (Online):2057-360X
Published Online:15 April 2020

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190634Outcome of cancer patients with critical illness requiring intensive care admissionDavid MorrisonCancer Research UK (CRUK)C47114/A16662HW - Public Health