Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit

Vincent, Jean-Louis, Marshall, John C., Namendys-Silva, Silvo A., Francois, Bruno, Martin-Loeches, Ignacio, Lipman, Jeffrey, Reinhart, Konrad, Antonelli, Massimo, Pickkers, Peter, Njimi, Hassane, Jimenez, Edgar and Sakr, Yasser (2014) Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. The Lancet Respiratory Medicine, 2 5: 380-386. doi:10.1016/S2213-2600(14)70061-X


Author Vincent, Jean-Louis
Marshall, John C.
Namendys-Silva, Silvo A.
Francois, Bruno
Martin-Loeches, Ignacio
Lipman, Jeffrey
Reinhart, Konrad
Antonelli, Massimo
Pickkers, Peter
Njimi, Hassane
Jimenez, Edgar
Sakr, Yasser
Title Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit
Journal name The Lancet Respiratory Medicine   Check publisher's open access policy
ISSN 2213-2600
2213-2619
Publication date 2014-05
Year available 2014
Sub-type Article (original research)
DOI 10.1016/S2213-2600(14)70061-X
Open Access Status
Volume 2
Issue 5
Start page 380
End page 386
Total pages 7
Place of publication London, United Kingdom
Publisher Lancet Publishing Group
Collection year 2015
Language eng
Formatted abstract
Background: Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality.

Methods: 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country.

Findings: 10 069 patients were included from ICUs in Europe (5445 patients; 54·1%), Asia (1928; 19·2%), the Americas (1723; 17·1%), Oceania (439; 4·4%), the Middle East (393; 3·9%), and Africa (141; 1·4%). Overall, 2973 patients (29·5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16·2% (95% CI 15·5-16·9) across the whole population and 25·8% (24·2-27·4) in patients with sepsis. Hospital mortality rates were 22·4% (21·6-23·2) in the whole population and 35·3% (33·5-37·1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0·19, p=0·002) and between-hospital variations (var=0·43, p<0·0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income.

Interpretation: This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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