Fernando G Zampieri1,2, Fernando A Bozza3,4, Giulliana M Moralez3,5, Débora D S Mazza6, Alexandre V Scotti7, Marcelo S Santino8, Rubens A B Ribeiro9, Edison M Rodrigues Filho10, Maurício M Cabral11, Marcelo O Maia12, Patrícia S D'Alessandro13, Sandro V Oliveira14, Márcia A M Menezes15, Eliana B Caser16, Roberto S Lannes17, Meton S Alencar Neto18, Maristela M Machado19, Marcelo F Sousa20, Jorge I F Salluh3,21, Marcio Soares22,23. 1. Research Institute, Hospital do Coração (HCor), São Paulo, Brazil. 2. Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil. 3. Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil. 4. Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brazil. 5. Intensive Care Unit, Hospital Estadual Getúlio Vargas, Rio de Janeiro, Brazil. 6. Intensive Care Unit, Hospital São Luiz-Unidade Jabaquara, São Paulo, Brazil. 7. Intensive Care Unit, Hospital Israelita Albert Sabin, Rio de Janeiro, Brazil. 8. Intensive Care Unit, Hospital Barra D'Or, Rio de Janeiro, Brazil. 9. Intensive Care Unit, Hospital Anchieta, Taguatinga, Brazil. 10. Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil. 11. Intensive Care Unit, Hospital São Marcos, Recife, Brazil. 12. Intensive Care Unit, Hospital Santa Luzia, Brasília, Brazil. 13. Intensive Care Unit, Clínica São Vicente, Rio de Janeiro, Brazil. 14. Intensive Care Unit, Hospital Bangu, Rio de Janeiro, Brazil. 15. Intensive Care Unit, Hospital Oeste D'Or, Rio de Janeiro, Brazil. 16. Intensive Care Unit, Hospital Unimed Vitória, Vitória, Brazil. 17. Intensive Care Unit, Hospital Municipal Souza Aguiar, Rio de Janeiro, Brazil. 18. Intensive Care Unit, Hospital Regional do Cariri, Juazeiro do Norte, Brazil. 19. Intensive Care Unit, Hospital Agenor Paiva, Salvador, Brazil. 20. Intensive Care Unit, Santa Casa de Caridade de Diamantina, Diamantina, Brazil. 21. Postgraduate Program of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 22. Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil. marciosoaresms@gmail.com. 23. Postgraduate Program of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. marciosoaresms@gmail.com.
Abstract
PURPOSE: To assess the impact of performance status (PS) impairment 1 week before hospital admission on the outcomes in patients admitted to intensive care units (ICU). METHODS: Retrospective cohort study in 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We classified PS impairment according to the Eastern Cooperative Oncology Group (ECOG) scale in absent/minor (PS = 0-1), moderate (PS = 2) or severe (PS = 3-4). We used univariate and multivariate logistic regression analyses to investigate the association between PS impairment and hospital mortality. RESULTS: PS impairment was moderate in 17.3 % and severe in 6.9 % of patients. The hospital mortality was 14.4 %. Overall, the worse the PS, the higher the ICU and hospital mortality and length of stay. In addition, patients with worse PS were less frequently discharged home. PS impairment was associated with worse outcomes in all SAPS 3, Charlson Comorbidity Index and age quartiles as well as according to the admission type. Adjusting for other relevant clinical characteristics, PS impairment was associated with higher hospital mortality (odds-ratio (OR) = 1.96 (95 % CI 1.63-2.35), for moderate and OR = 4.22 (3.32-5.35), for severe impairment). The effects of PS on the outcome were particularly relevant in the medium range of severity-of-illness. These results were consistent in the subgroup analyses. However, adding PS impairment to the SAPS 3 score improved only slightly its discriminative capability. CONCLUSION: PS impairment was associated with worse outcomes independently of other markers of chronic health status, particularly for patients in the medium range of severity of illness.
PURPOSE: To assess the impact of performance status (PS) impairment 1 week before hospital admission on the outcomes in patients admitted to intensive care units (ICU). METHODS: Retrospective cohort study in 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We classified PS impairment according to the Eastern Cooperative Oncology Group (ECOG) scale in absent/minor (PS = 0-1), moderate (PS = 2) or severe (PS = 3-4). We used univariate and multivariate logistic regression analyses to investigate the association between PS impairment and hospital mortality. RESULTS: PS impairment was moderate in 17.3 % and severe in 6.9 % of patients. The hospital mortality was 14.4 %. Overall, the worse the PS, the higher the ICU and hospital mortality and length of stay. In addition, patients with worse PS were less frequently discharged home. PS impairment was associated with worse outcomes in all SAPS 3, Charlson Comorbidity Index and age quartiles as well as according to the admission type. Adjusting for other relevant clinical characteristics, PS impairment was associated with higher hospital mortality (odds-ratio (OR) = 1.96 (95 % CI 1.63-2.35), for moderate and OR = 4.22 (3.32-5.35), for severe impairment). The effects of PS on the outcome were particularly relevant in the medium range of severity-of-illness. These results were consistent in the subgroup analyses. However, adding PS impairment to the SAPS 3 score improved only slightly its discriminative capability. CONCLUSION: PS impairment was associated with worse outcomes independently of other markers of chronic health status, particularly for patients in the medium range of severity of illness.
Entities:
Keywords:
Critical care; Markers of baseline health status; Outcomes; Performance status
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