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Inicio Medicina Clínica (English Edition) Short- and long-term prognosis of critically-ill patients referred to the ICU fr...
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Vol. 148. Issue 5.
Pages 197-203 (March 2017)
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Vol. 148. Issue 5.
Pages 197-203 (March 2017)
Original article
Short- and long-term prognosis of critically-ill patients referred to the ICU from the Emergency Department of a tertiary hospital
Pronóstico a corto y largo plazo de los pacientes críticos ingresados en la Unidad de Cuidados Intensivos desde el Servicio de Urgencias de un hospital terciario
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Renata García-Gigorro
Corresponding author
rennygg@hotmail.com

Corresponding author.
, Helena Dominguez Aguado, Jesús Abelardo Barea Mendoza, Rubén Viejo Moreno, Jose Angel Sánchez Izquierdo, Juan Carlos Montejo-González
Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
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Med Clin. 2017;148:215-710.1016/j.medcle.2016.12.053
Sebastián Iribarren Diarasarri
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Tables (4)
Table 1. Univariate analysis of factors associated with hospital mortality.
Table 2. Multivariate analysis of factors associated with hospital mortality.
Table 3. Univariate analysis of factors associated with long-term hospital mortality.
Table 4. Multivariate analysis of factors associated with long-term mortality.
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Abstract
Background and objective

A frequent source of critically-ill patients admitted to the ICU is the Emergency Department. It is essential to analyze the short-term prognosis of these patients, but also their evolution after their discharge from the hospital, since this is one of the major concerns of these patients. The aim of this study is to describe the epidemiological characteristics of patients admitted to the ICU from the Emergency Department and to analyze their outcome.

Patients and method

This consisted of an observational prospective cohorts study which included 269 Emergency Department patients consecutively admitted to the ICU over an 18-month period. Factors associated with hospital mortality were presented as an odds ratio (OR) and factors associated with long-term mortality were presented as a hazard ratio (HR). A P-value lower than .05 was accepted as significant. The overall survival was analyzed on the basis of the Kaplan–Meier curves.

Results

Hospital mortality was 15%, ICU complications where the variables with the greatest impact on short-term mortality: acute renal failure (OR 22.7) and respiratory distress syndrome (OR 51.2). After hospital discharge, the cumulative mortality at 12, 24 and 36 months was 6, 11 and 15%, respectively. The degree of functional dependence (HR 3.7), cancer (HR 3.4) and arrhythmias (HR 2.4) were factors related to long-term mortality.

Conclusions

The short-term outcome of ICU patients is related to age and comorbidity, but more significantly to the characteristics of the acute illness. However, the long-term outcome is more closely associated with the patients’ characteristics.

Keywords:
Emergency Department
Intensive care
Hospital mortality
Long-term mortality
Resumen
Antecedentes y objetivo

Un origen frecuente de los pacientes que ingresan en la UCI es el Servicio de Urgencias. Es necesario analizar el pronóstico a corto plazo de estos pacientes, pero también su evolución tras el alta hospitalaria, puesto que es una preocupación importante de los enfermos. Nuestro objetivo es describir las características epidemiológicas de los pacientes que ingresan en la UCI desde Urgencias y analizar su evolución.

Pacientes y método

Estudio de cohortes observacional y prospectivo. Incluye 269 pacientes ingresados consecutivamente en la UCI desde Urgencias durante 18 meses. Los factores asociados a la mortalidad hospitalaria se presentan en odds ratio (OR) y a la mortalidad a largo plazo como hazard ratio (HR). El nivel de significación aceptado fue del 5%. La supervivencia global se analizó mediante curvas de Kaplan–Meier.

Resultados

La mortalidad hospitalaria fue del 15%, las complicaciones desarrolladas en la UCI fueron las variables con mayor impacto en la misma: insuficiencia renal aguda (OR 22,7) y distrés respiratorio (OR 51,2). Tras el alta hospitalaria, la mortalidad acumulada a los 12, 24 y 36 meses fue del 6, 11 y 15%, respectivamente. El grado de dependencia funcional (HR 3,7), el cáncer (HR 3,4) y las arritmias (HR 2,4) fueron los factores relacionados con la mortalidad a largo plazo.

Conclusiones

El pronóstico a corto plazo de los pacientes que ingresan en la UCI se relaciona con su edad y comorbilidad, pero sobre todo con las características de la enfermedad aguda. Sin embargo, la evolución a largo plazo está más asociada a las características del paciente.

Palabras clave:
Servicio de Urgencias
Cuidados intensivos
Mortalidad hospitalaria
Mortalidad a largo plazo

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