The effects of performance status one week before hospital admission on the outcomes of critically ill patients

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 i...

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Bibliographic Details
Published in:	Intensive care medicine 2017-01, Vol.43 (1), p.39-47
Main Authors:	Zampieri, Fernando G., Bozza, Fernando A., Moralez, Giulliana M., Mazza, Débora D. S., Scotti, Alexandre V., Santino, Marcelo S., Ribeiro, Rubens A. B., Rodrigues Filho, Edison M., Cabral, Maurício M., Maia, Marcelo O., D’Alessandro, Patrícia S., Oliveira, Sandro V., Menezes, Márcia A. M., Caser, Eliana B., Lannes, Roberto S., Alencar Neto, Meton S., Machado, Maristela M., Sousa, Marcelo F., Salluh, Jorge I. F., Soares, Marcio
Format:	Article
Language:	eng
Subjects:	Activities of daily living Admission and discharge Adult Aged Aged, 80 and over Analysis Anesthesiology Brazil Cohort Studies Comorbidity Critical care Critical Care Medicine Critical Illness - therapy Emergency Medicine Female Health Status Health Status Indicators Hospitals Humans Illnesses Intensive Intensive care Male Medical research Medicine Medicine & Public Health Medicine, Experimental Middle Aged Mortality Original Pain Medicine Patient outcomes Patients Pediatrics Pneumology/Respiratory System Retrospective Studies Sepsis Severity of Illness Index Treatment Outcome
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Summary:	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.
ISSN:	0342-4642 1432-1238