Determinants of long-term survival after intensive care

Williams, Teresa A., Dobb, Geoffrey J., Finn, Judith Claire, Knuiman, Matthew William, Geelhoed, Elizabeth, Lee, K. Y. and Webb, Steven A. R. (2008) Determinants of long-term survival after intensive care. Critical Care Medicine, 36 5: 1523-1530. doi:10.1097/CCM.0b013e318170a405

Author Williams, Teresa A.
Dobb, Geoffrey J.
Finn, Judith Claire
Knuiman, Matthew William
Geelhoed, Elizabeth
Lee, K. Y.
Webb, Steven A. R.
Title Determinants of long-term survival after intensive care
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
Publication date 2008-05
Sub-type Article (original research)
DOI 10.1097/CCM.0b013e318170a405
Open Access Status
Volume 36
Issue 5
Start page 1523
End page 1530
Total pages 8
Place of publication Baltimore, MD, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
OBJECTIVE: To identify prognostic determinants of long-term survival for patients treated in intensive care units (ICUs) who survived to hospital discharge.

DESIGN: An ICU clinical cohort linked to state-wide hospital records and death registers.

SETTING AND PATIENTS: Adult patients admitted to a 22-bed ICU at a major teaching hospital in Perth, Western Australia, between 1987 and 2002 who survived to hospital discharge (n = 19,921) were followed-up until December 31, 2003.

MEASUREMENTS: The main outcome measures are crude and adjusted survival.

MAIN RESULTS: The risk of death in the first year after hospital discharge was high for patients who survived the ICU compared with the general population (standardized mortality rate [SMR] at 1 yr = 2.90, 95% confidence interval [CI] 2.73-3.08) and remained higher than the general population for every year during 15 yrs of follow up (SMR at 15 yrs = 2.01, 95% CI 1.64-2.46). Factors that were independently associated with survival during the first year were older age (hazard ratio [HR] = 4.09; 95% CI 3.20-5.23), severe comorbidity (HR = 5.23; 95% CI 4.25-6.43), ICU diagnostic group (HR range 2.20 to 8.95), new malignancy (HR = 4.60; 95% CI 3.68-5.76), high acute physiology score on admission (HR = 1.55; 95% CI 1.23-1.96), and peak number of organ failures (HR = 1.51; 95% CI 1.11-2.04). All of these factors were independently associated with subsequent survival for those patients who were alive 1 yr after discharge from the hospital with the addition of male gender (HR = 1.17; 95% CI 1.10-1.25) and prolonged length of stay in ICU (HR = 1.42; 95% CI 1.29-1.55).

CONCLUSIONS: Patients who survived an admission to the ICU have worse survival than the general population for at least 15 yrs. The factors that determine long-term survival include age, comorbidity, and primary diagnosis. Severity of illness was also associated with long-term survival and this suggests that an episode of critical illness, or its treatment, may shorten life-expectancy.
Keyword Cohort studies
Critical illness
Data linkage
Intensive care units
Outcomes research
Survival analysis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 81 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 89 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Wed, 30 Jul 2014, 15:06:44 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work