Risk Management and Healthcare Policy (Apr 2021)
Risk Factors for 28-Day Mortality in a Surgical ICU: A Retrospective Analysis of 347 Cases
Abstract
Yuanyuan Zhang,1,2 Jia Zhang,2,3 Zhaoqing Du,2,4 Yifan Ren,2,5 Jieming Nie,6 Zheng Wu,3 Yi Lv,2,3 Jianbin Bi,2,7 Rongqian Wu2 1Department of Pediatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; 2National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; 3Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; 4Department of General Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; 5Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, People’s Republic of China; 6Department of Internal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China; 7Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of ChinaCorrespondence: Rongqian Wu; Jianbin BiNational Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, 76 West Yanta Road, P.O. Box 124, Xi’an, Shaanxi Province, 710061, People’s Republic of ChinaTel +86 29 8265 7541Email [email protected]; [email protected]: Advances in surgical techniques and intensive care over the past decades have significantly reduced the mortality rates of critically ill surgical patients. However, evaluations of risk factors associated with mortality in surgical intensive care units (ICUs) are limited. The aim of this study was to analyze the independent risk factors for 28-day mortality of surgical ICU patients.Patients and Methods: The clinical data of adult patients who were admitted to the surgical ICU in the First Affiliated Hospital of Xi’an Jiaotong University from June 2013 to June 2017 were collected. Univariate and multivariable logistic regression analyses were performed to examine risk factors associated with 28-day mortality.Results: A total of 347 patients were included in this analysis. The overall 28-day mortality rate was 32.6%. The major causes of surgical ICU admission were gastrointestinal diseases (46.7%), infection (20.5%), trauma (8.9%), respiratory diseases (8.9%) and cardiovascular diseases (6.6%). The univariate analysis showed age, total bilirubin, prothrombin time, international normalized ratio, arterial lactate level, APACHE II and SOFA score at ICU admission were significantly associated with 28-day mortality. In the multivariate analysis, however, age [Odds Ratio (OR): 2.899, 95% CI: 1.427– 5.890, P=0.003], hypertension [OR: 3.630, 95% CI: 1.545– 8.531, P=0.003], platelet count [OR: 1.004, 95% CI: 1.001– 1.007, P=0.015], arterial lactate level [OR: 1.186, 95% CI: 1.088– 1.293, P< 0.001] and SOFA score [OR: 1.289, 95% CI: 1.131– 1.469, P< 0.001] were identified as the independent risk factors for 28-day mortality of patients in the surgical ICU.Conclusion: In patients admitted to the surgical ICU, age 65 and older, a high arterial lactate level and SOFA score at ICU admission were associated with increased 28-day mortality.Keywords: critical care, surgical intensive care units, 28-day mortality, clinical characteristics
