Mortality Predictors and Associated Factors in Patients in the Intensive Care Unit: A Cross-Sectional Study
Fernanda Gomes de Magalhães Soares Pinheiro, Eduesley Santana Santos, Íkaro Daniel de Carvalho Barreto, Carleara Weiss, Andréia Centenaro Vaez, Jussiely Cunha Oliveira, Matheus Santos Melo, Francilene A. Silva
Abstract
Background . Mortality in the intensive care unit (ICU) has been associated to an array of risk factors. Identification of risk factors potentially contribute to predict and reduce mortality rates in the ICU. The objectives of the study were to determine the prevalence and the factors associated with the mortality and to analyze the survival. Method . A cross-sectional study conducted in two clinical and surgical ICU in the state of Sergipe, northeastern Brazil. We enrolled 316 patients with at least 48 h of hospitalization, minimum age of 18 years old, sedated or weaned, with RASS ≥ −3, between July 2017 and April 2018. We categorized data in (1) age and gender, (2) clinical condition, and (3) prevalence of delirium. Data from enrolled patients were collected from enrollment until death or ICU discharge. Patients’ outcomes were categorized in (1) death and (2) nondeath (discharge). Results . Twenty-one percent of participants died. Age (53 ± 17 years vs . 45 ± 18 years, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>p</mml:mi><mml:mo><</mml:mo><mml:mn>0.01</mml:mn></mml:math>), electrolyte disturbance (30.3% vs 18.1%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.029</mml:mn></mml:math>), glycemic index (33.3% vs 18.2%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.008</mml:mn></mml:math>), tube feeding (83.3% vs 67.1%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.01</mml:mn></mml:math>), mechanical ventilation (50% vs 35.7%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.035</mml:mn></mml:math>), sedation with fentanyl (24.2 vs 13.6, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.035</mml:mn></mml:math>), use of insulin (33.8% vs 21.7%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.042</mml:mn></mml:math>), and higher Charlson score (2.61 vs 2.17, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.041</mml:mn></mml:math>) were significantly associated with death on the adjusted model. However, the regression model indicated that patients admitted from the emergency (HR = 0.40, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.006</mml:mn></mml:math>) and glycemic index alterations (HR = 1.68, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M10"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.047</mml:mn></mml:math>) were associated with mortality. There was no statistically significant difference (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M11"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.540</mml:mn></mml:math>) in survival between patients with and without delirium, based on the survival analysis and length of hospitalization. Conclusion . The prevalence of death was 21%, and age, electrolyte disturbance, glycemic index, tube feeding, mechanical ventilation, sedation with fentanyl, use of insulin, and higher Charlson score were associated with mortality.