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ORIGINAL ARTICLE
Frailty influences clinical outcomes in critical patients: a post hoc analysis of the PalMuSIC study
Critical Care Science. 2025;37:e20250229
05-07-2025
Abstract
ORIGINAL ARTICLEFrailty influences clinical outcomes in critical patients: a post hoc analysis of the PalMuSIC study
Critical Care Science. 2025;37:e20250229
05-07-2025DOI 10.62675/2965-2774.20250229
Views44ABSTRACT
Objective:
Frailty is a multidimensional syndrome characterized by diminished physiological reserve, increasing the risk of adverse outcomes, particularly in intensive care unit patients. The Clinical Frailty Scale, ranging from 1 (nonfrail) to 9 (terminally ill), is widely used to quantify frailty. This post hoc analysis of the Palliative Multicenter Study in Intensive Care (PalMuSIC) assesses the impact of frailty and clinical severity on short- and long-term outcomes.
Methods:
This subanalysis involved 23 Portuguese intensive care units and 335 patients. Patients admitted between March 1 and May 15, 2019, aged ≥ 18 years, and hospitalized for > 24 hours in the intensive care unit were eligible. The severity of illness was assessed using SAPS II, and frailty was assessed using the clinical frailty scale, which was recorded by a nurse and a doctor in charge. Patients were classified as frail (clinical frailty scale score ≥ 5), prefrail (clinical frailty scale score = 4), or nonfrail (clinical frailty scale score < 4). The outcomes measured included intensive care unit and hospital LOS (length of stay), need for organ support, infections, mortality at hospital discharge and mortality at 6 months post discharge. We divided the population in half according to the length of their intensive care unit stay to evaluate a possible interaction between intensive care unit length of stay and frailty.
Results:
The mean age was 63.2 years, and 66% were male. The mean SAPS II score was 41.8. Frailty was observed in 23.0% of the patients. Frail patients had higher hospital mortality (39.0% frail patients versus 28.2% prefrail patients versus 11.8% nonfrail patients) and 6-month mortality (frail 49.4% frail patients versus 30.6% prefrail patients versus 15.6% nonfrail patients). Patients with longer intensive care unit stays had higher 6-month mortality rates than did those with shorter intensive care unit stays did, which resulted in more frail patients: odds ratio (95% confidence interval) 3.1 (1.2 - 7.8) versus odds ratio 1.8 (0.9 - 4.0) in nonfrail patients.
Conclusion:
Frailty may significantly impact hospital and 6-month mortality. In our cohort, a longer intensive care unit length of stay was associated with worse long-term outcomes, especially in frail patients.
Keywords:Clinical frailty scaleCritical care outcomesFrail elderlyFrailtyintensive care unitsLength of staymortalitySee moreViews44
Abstract
ORIGINAL ARTICLEFrailty influences clinical outcomes in critical patients: a post hoc analysis of the PalMuSIC study
Critical Care Science. 2025;37:e20250229
05-07-2025DOI 10.62675/2965-2774.20250229
Views44ABSTRACT
Objective:
Frailty is a multidimensional syndrome characterized by diminished physiological reserve, increasing the risk of adverse outcomes, particularly in intensive care unit patients. The Clinical Frailty Scale, ranging from 1 (nonfrail) to 9 (terminally ill), is widely used to quantify frailty. This post hoc analysis of the Palliative Multicenter Study in Intensive Care (PalMuSIC) assesses the impact of frailty and clinical severity on short- and long-term outcomes.
Methods:
This subanalysis involved 23 Portuguese intensive care units and 335 patients. Patients admitted between March 1 and May 15, 2019, aged ≥ 18 years, and hospitalized for > 24 hours in the intensive care unit were eligible. The severity of illness was assessed using SAPS II, and frailty was assessed using the clinical frailty scale, which was recorded by a nurse and a doctor in charge. Patients were classified as frail (clinical frailty scale score ≥ 5), prefrail (clinical frailty scale score = 4), or nonfrail (clinical frailty scale score < 4). The outcomes measured included intensive care unit and hospital LOS (length of stay), need for organ support, infections, mortality at hospital discharge and mortality at 6 months post discharge. We divided the population in half according to the length of their intensive care unit stay to evaluate a possible interaction between intensive care unit length of stay and frailty.
Results:
The mean age was 63.2 years, and 66% were male. The mean SAPS II score was 41.8. Frailty was observed in 23.0% of the patients. Frail patients had higher hospital mortality (39.0% frail patients versus 28.2% prefrail patients versus 11.8% nonfrail patients) and 6-month mortality (frail 49.4% frail patients versus 30.6% prefrail patients versus 15.6% nonfrail patients). Patients with longer intensive care unit stays had higher 6-month mortality rates than did those with shorter intensive care unit stays did, which resulted in more frail patients: odds ratio (95% confidence interval) 3.1 (1.2 - 7.8) versus odds ratio 1.8 (0.9 - 4.0) in nonfrail patients.
Conclusion:
Frailty may significantly impact hospital and 6-month mortality. In our cohort, a longer intensive care unit length of stay was associated with worse long-term outcomes, especially in frail patients.
Keywords:Clinical frailty scaleCritical care outcomesFrail elderlyFrailtyintensive care unitsLength of staymortalitySee more
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CLINICAL REPORT
Evaluation of prognostic factors for mortality in cancer patients with sepsis in the intensive care unit: systematic review protocol
- María Fernanda García-Aguilera
, - Nayely García-Méndez ,
- Glenn Hernández ,
- Borja M. Fernández-Félix ,
- Harold Alexander-León , [ ... ],
- Carlos Manterola
04-22-2025
Abstract
CLINICAL REPORTEvaluation of prognostic factors for mortality in cancer patients with sepsis in the intensive care unit: systematic review protocol
Critical Care Science. 2025;37:e20250283
04-22-2025DOI 10.62675/2965-2774.20250283
- María Fernanda García-Aguilera ,
- Nayely García-Méndez ,
- Glenn Hernández ,
- Borja M. Fernández-Félix ,
- Harold Alexander-León ,
- Yunqi Yu-Liu ,
- Josue Rivadeneira ,
- Luis Fuenmayor-González ,
- Cristopher Isaac Peña Robayo ,
- Fernanda Villalba ,
- Eduardo Andrés Aragundi Palacios ,
- Emérita Eugenia Basantes Borja ,
- Henry Caballero Narvaez ,
- Isabel Morales Alcocer ,
- Eduardo Velazco ,
- Georgina Muñoz ,
- Juan Pablo Holguín-Carvajal ,
- Tamara Otzen Hernández ,
- Carlos Manterola
Views72See moreABSTRACT
Introduction:
This systematic review outlines a comprehensive approach to identify and analyze prognostic factors associated with mortality in adult cancer patients with sepsis in the intensive care unit. The review will focus on all-cause 28-day mortality, and where not available, we will use 30-day, intensive care unit, or in-hospital mortality.
Methods and analysis:
We present a protocol for the systematic review of prognostic factors for mortality in adult cancer patients with sepsis managed in the intensive care unit. Our primary outcome is 28-day mortality, and where not available, we will use 30-day, intensive care unit, or in-hospital mortality. The secondary outcome is the global mortality incidence. Studies on the basis of the population (sepsis and neoplasms), prognostic study methods and outcome of interest (mortality) will be included. We will search the following databases: Medline, PubMed, EMBASE, SCOPUS, Web of Science, and Bireme-BVS, until April 5, 2024. The risk of bias will be assessed using the QUIPS tool. A meta-analysis will be conducted where possible to generate pooled estimates for identified prognostic factors. Two authors will independently assess the risk of bias in each study using the Quality in Prognostic Studies tool. The GRADE approach will be employed to evaluate the overall quality of evidence and the strength of the recommendations. Findings will be disseminated through publication in a peer-reviewed journal. This review aims to provide clinicians with valuable insights into factors influencing mortality risk in this high-risk population, ultimately informing clinical decision-making and improving patient outcomes.
Ethics and socialization:
The results of this review will be published in a peer-reviewed scientific journal. Does not require ethical approval.
Views72Abstract
CLINICAL REPORTEvaluation of prognostic factors for mortality in cancer patients with sepsis in the intensive care unit: systematic review protocol
Critical Care Science. 2025;37:e20250283
04-22-2025DOI 10.62675/2965-2774.20250283
- María Fernanda García-Aguilera ,
- Nayely García-Méndez ,
- Glenn Hernández ,
- Borja M. Fernández-Félix ,
- Harold Alexander-León ,
- Yunqi Yu-Liu ,
- Josue Rivadeneira ,
- Luis Fuenmayor-González ,
- Cristopher Isaac Peña Robayo ,
- Fernanda Villalba ,
- Eduardo Andrés Aragundi Palacios ,
- Emérita Eugenia Basantes Borja ,
- Henry Caballero Narvaez ,
- Isabel Morales Alcocer ,
- Eduardo Velazco ,
- Georgina Muñoz ,
- Juan Pablo Holguín-Carvajal ,
- Tamara Otzen Hernández ,
- Carlos Manterola
Views72See moreABSTRACT
Introduction:
This systematic review outlines a comprehensive approach to identify and analyze prognostic factors associated with mortality in adult cancer patients with sepsis in the intensive care unit. The review will focus on all-cause 28-day mortality, and where not available, we will use 30-day, intensive care unit, or in-hospital mortality.
Methods and analysis:
We present a protocol for the systematic review of prognostic factors for mortality in adult cancer patients with sepsis managed in the intensive care unit. Our primary outcome is 28-day mortality, and where not available, we will use 30-day, intensive care unit, or in-hospital mortality. The secondary outcome is the global mortality incidence. Studies on the basis of the population (sepsis and neoplasms), prognostic study methods and outcome of interest (mortality) will be included. We will search the following databases: Medline, PubMed, EMBASE, SCOPUS, Web of Science, and Bireme-BVS, until April 5, 2024. The risk of bias will be assessed using the QUIPS tool. A meta-analysis will be conducted where possible to generate pooled estimates for identified prognostic factors. Two authors will independently assess the risk of bias in each study using the Quality in Prognostic Studies tool. The GRADE approach will be employed to evaluate the overall quality of evidence and the strength of the recommendations. Findings will be disseminated through publication in a peer-reviewed journal. This review aims to provide clinicians with valuable insights into factors influencing mortality risk in this high-risk population, ultimately informing clinical decision-making and improving patient outcomes.
Ethics and socialization:
The results of this review will be published in a peer-reviewed scientific journal. Does not require ethical approval.
- María Fernanda García-Aguilera
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CLINICAL REPORT
Multicenter observational study of patients who underwent cardiac surgery and were hospitalized in an intensive care unit (BraSIS 2): study protocol and statistical analysis plan
- Nair Naiara Barros de Vasconcelos ,
- Renato Carneiro de Freitas Chaves ,
- Carolina de Moraes Pellegrino,
- Guilherme Martins de Souza ,
- Veronica Neves Fialho Queiroz , [ ... ],
- João Manoel Silva Júnior
02-28-2025
Abstract
CLINICAL REPORTMulticenter observational study of patients who underwent cardiac surgery and were hospitalized in an intensive care unit (BraSIS 2): study protocol and statistical analysis plan
Critical Care Science. 2025;37:e20250222
02-28-2025DOI 10.62675/2965-2774.20250222
- Nair Naiara Barros de Vasconcelos ,
- Renato Carneiro de Freitas Chaves ,
- Carolina de Moraes Pellegrino,
- Guilherme Martins de Souza ,
- Veronica Neves Fialho Queiroz ,
- Carmen Silvia Valente Barbas ,
- Flávio Takaoka ,
- Ricardo Luiz Cordioli ,
- Sandrigo Mangini ,
- Fabio de Vasconcelos Papa ,
- Hélio Penna Guimarães ,
- Adriano José Pereira ,
- Ary Serpa Neto ,
- Andre Gulinelli,
- Anna Clara Legal ,
- Caio Vinicius Gouvêa Jaoude ,
- Eduardo Paolinelli,
- Eric Benedet Lineburger ,
- Erick César de Farias Albuquerque,
- Evaldo Gomes Ferreira Filho,
- Fabio Barlem Hohmann ,
- Felipe Galdino,
- Felipe Souza Lima Vianna ,
- Frederico Toledo Campo Dall’Orto ,
- Lucas Tramujas ,
- Luciano Ribeiro Pereira Silva ,
- Maxim Goncharov ,
- Paulo César Gottardo ,
- Roberto Rabello Filho ,
- Thais Dias Midega ,
- Vinicius Barbosa Galindo ,
- Vinícius Caldeira Quintão ,
- Viviane Cordeiro Veiga ,
- Thiago Domingos Corrêa ,
- João Manoel Silva Júnior
Views114See moreABSTRACT
Background
The perioperative management of patients undergoing cardiac surgery is highly complex and involves numerous factors. There is a strong association between cardiac surgery and perioperative complications. The Brazilian Surgical Identification Study (BraSIS 2) aims to assess the incidence of death and early postoperative complications, identify potential risk factors, and examine both the demographic characteristics of patients and the epidemiology of cardiovascular procedures.
Methods and analysis
BraSIS 2 is a multicenter observational study of patients who undergo cardiac surgery and who are admitted to the intensive care unit. The primary objective is to describe the risk factors and incidence of mortality or severe postoperative complications occurring within the first 3 postoperative days of cardiac surgery or until intensive care unit discharge (whichever event occurs first). Severe postoperative complications include acute myocardial infarction, acute respiratory distress syndrome, cardiorespiratory arrest with return of spontaneous circulation, Kidney Disease Improving Global Outcomes stage ≥ 2, a new surgical approach being conducted in an unscheduled event of urgency or emergency, renal replacement therapy, septic shock, severe bleeding, severe hemodynamic instability, stroke, unplanned reintubation, and unplanned use of a circulatory assistance device. The secondary outcomes include the evaluation of patient characteristics and descriptions of the performed surgeries and administered anesthesia. This study will also assess intraoperative and postoperative complications, as well as risk factors associated with postoperative complications and mortality. We expect to recruit 500 patients from at least 10 Brazilian intensive care units. Trial registration: NCT06154473; partial results.
Views114Abstract
CLINICAL REPORTMulticenter observational study of patients who underwent cardiac surgery and were hospitalized in an intensive care unit (BraSIS 2): study protocol and statistical analysis plan
Critical Care Science. 2025;37:e20250222
02-28-2025DOI 10.62675/2965-2774.20250222
- Nair Naiara Barros de Vasconcelos ,
- Renato Carneiro de Freitas Chaves ,
- Carolina de Moraes Pellegrino,
- Guilherme Martins de Souza ,
- Veronica Neves Fialho Queiroz ,
- Carmen Silvia Valente Barbas ,
- Flávio Takaoka ,
- Ricardo Luiz Cordioli ,
- Sandrigo Mangini ,
- Fabio de Vasconcelos Papa ,
- Hélio Penna Guimarães ,
- Adriano José Pereira ,
- Ary Serpa Neto ,
- Andre Gulinelli,
- Anna Clara Legal ,
- Caio Vinicius Gouvêa Jaoude ,
- Eduardo Paolinelli,
- Eric Benedet Lineburger ,
- Erick César de Farias Albuquerque,
- Evaldo Gomes Ferreira Filho,
- Fabio Barlem Hohmann ,
- Felipe Galdino,
- Felipe Souza Lima Vianna ,
- Frederico Toledo Campo Dall’Orto ,
- Lucas Tramujas ,
- Luciano Ribeiro Pereira Silva ,
- Maxim Goncharov ,
- Paulo César Gottardo ,
- Roberto Rabello Filho ,
- Thais Dias Midega ,
- Vinicius Barbosa Galindo ,
- Vinícius Caldeira Quintão ,
- Viviane Cordeiro Veiga ,
- Thiago Domingos Corrêa ,
- João Manoel Silva Júnior
Views114See moreABSTRACT
Background
The perioperative management of patients undergoing cardiac surgery is highly complex and involves numerous factors. There is a strong association between cardiac surgery and perioperative complications. The Brazilian Surgical Identification Study (BraSIS 2) aims to assess the incidence of death and early postoperative complications, identify potential risk factors, and examine both the demographic characteristics of patients and the epidemiology of cardiovascular procedures.
Methods and analysis
BraSIS 2 is a multicenter observational study of patients who undergo cardiac surgery and who are admitted to the intensive care unit. The primary objective is to describe the risk factors and incidence of mortality or severe postoperative complications occurring within the first 3 postoperative days of cardiac surgery or until intensive care unit discharge (whichever event occurs first). Severe postoperative complications include acute myocardial infarction, acute respiratory distress syndrome, cardiorespiratory arrest with return of spontaneous circulation, Kidney Disease Improving Global Outcomes stage ≥ 2, a new surgical approach being conducted in an unscheduled event of urgency or emergency, renal replacement therapy, septic shock, severe bleeding, severe hemodynamic instability, stroke, unplanned reintubation, and unplanned use of a circulatory assistance device. The secondary outcomes include the evaluation of patient characteristics and descriptions of the performed surgeries and administered anesthesia. This study will also assess intraoperative and postoperative complications, as well as risk factors associated with postoperative complications and mortality. We expect to recruit 500 patients from at least 10 Brazilian intensive care units. Trial registration: NCT06154473; partial results.
- Nair Naiara Barros de Vasconcelos
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ORIGINAL ARTICLE
Sepsis survivors readmitted within 30 days: outcomes of a single-center retrospective study
- Abdelrahman Nanah ,
- Fatima Abdeljaleel ,
- Marcos Vinícius Fernandes Garcia ,
- Kelly Pannikodu,
- Mohannad Seif, [ ... ],
- Divyajot Sadana
11-26-2024
Abstract
ORIGINAL ARTICLESepsis survivors readmitted within 30 days: outcomes of a single-center retrospective study
Critical Care Science. 2024;36:e20240116en
11-26-2024DOI 10.62675/2965-2774.20240116-en
- Abdelrahman Nanah ,
- Fatima Abdeljaleel ,
- Marcos Vinícius Fernandes Garcia ,
- Kelly Pannikodu,
- Mohannad Seif,
- Amy Flowers-Surovi,
- Naveen Gopal,
- Divyajot Sadana
Views68See moreABSTRACT
Objective:
To investigate a cohort of sepsis survivors readmitted within 30 days postdischarge, explore the one-year mortality rate based on different causes of readmission and identify factors associated with increased one-year mortality risk among all sepsis survivors readmitted within this timeframe.
Methods:
This was a single-center retrospective cohort study involving adult sepsis survivors who were readmitted within 30 days of discharge. Patients were categorized into 3 groups based on the cause of readmission: same-source infectious readmission, different-source infectious readmission, and noninfectious readmission. The outcome of interest was all-cause one-year mortality. Cox proportional hazard analysis was performed to compare factors associated with one-year mortality.
Results:
Of the 1,666 patients admitted with sepsis, 243 (14.5%) were readmitted within 30 days. Readmissions were due to same-source infections (40.7%), different-source infections (21.4%), or noninfectious causes (37.9%). All-cause one-year mortality was 46.9%, with no difference between the groups. Age (HR 1.02; 95%CI: 1.003 - 1.04; p = 0.01), Sequential Organ Failure Assessment score (HR 1.1; 95%CI: 1.02 - 1.18; p = 0.01), discharge to a care facility during index admission (HR 1.6; 95%CI: 1.04 - 2.40; p = 0.03), and malignancy (HR 2.3; 95%CI: 1.5 - 3.7; p < 0.001) were associated with one-year mortality.
Conclusion:
Thirty-day readmission in sepsis survivors was common and was associated with a 46.9% one-year mortality rate regardless of readmission cause. Quality improvement patient safety initiatives based on local institutional factors may allow for targeted interventions to improve sepsis survivor outcomes.
Views68Abstract
ORIGINAL ARTICLESepsis survivors readmitted within 30 days: outcomes of a single-center retrospective study
Critical Care Science. 2024;36:e20240116en
11-26-2024DOI 10.62675/2965-2774.20240116-en
- Abdelrahman Nanah ,
- Fatima Abdeljaleel ,
- Marcos Vinícius Fernandes Garcia ,
- Kelly Pannikodu,
- Mohannad Seif,
- Amy Flowers-Surovi,
- Naveen Gopal,
- Divyajot Sadana
Views68See moreABSTRACT
Objective:
To investigate a cohort of sepsis survivors readmitted within 30 days postdischarge, explore the one-year mortality rate based on different causes of readmission and identify factors associated with increased one-year mortality risk among all sepsis survivors readmitted within this timeframe.
Methods:
This was a single-center retrospective cohort study involving adult sepsis survivors who were readmitted within 30 days of discharge. Patients were categorized into 3 groups based on the cause of readmission: same-source infectious readmission, different-source infectious readmission, and noninfectious readmission. The outcome of interest was all-cause one-year mortality. Cox proportional hazard analysis was performed to compare factors associated with one-year mortality.
Results:
Of the 1,666 patients admitted with sepsis, 243 (14.5%) were readmitted within 30 days. Readmissions were due to same-source infections (40.7%), different-source infections (21.4%), or noninfectious causes (37.9%). All-cause one-year mortality was 46.9%, with no difference between the groups. Age (HR 1.02; 95%CI: 1.003 - 1.04; p = 0.01), Sequential Organ Failure Assessment score (HR 1.1; 95%CI: 1.02 - 1.18; p = 0.01), discharge to a care facility during index admission (HR 1.6; 95%CI: 1.04 - 2.40; p = 0.03), and malignancy (HR 2.3; 95%CI: 1.5 - 3.7; p < 0.001) were associated with one-year mortality.
Conclusion:
Thirty-day readmission in sepsis survivors was common and was associated with a 46.9% one-year mortality rate regardless of readmission cause. Quality improvement patient safety initiatives based on local institutional factors may allow for targeted interventions to improve sepsis survivor outcomes.
- Abdelrahman Nanah
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ORIGINAL ARTICLE
Differences in the relative importance of predictors of short- and long-term mortality among critically ill patients with cancer
- Carla Marchini Dias da Silva ,
- Bárbara Beltrame Bettim ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Antônio Paulo Nassar Junior
11-11-2024
Abstract
ORIGINAL ARTICLEDifferences in the relative importance of predictors of short- and long-term mortality among critically ill patients with cancer
Critical Care Science. 2024;36:e20240149en
11-11-2024DOI 10.62675/2965-2774.20240149-en
- Carla Marchini Dias da Silva ,
- Bárbara Beltrame Bettim ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Antônio Paulo Nassar Junior
Views94See moreABSTRACT
Objective:
To identify the relative importance of several clinical variables present at intensive care unit admission on the short- and long-term mortality of critically ill patients with cancer after unplanned intensive care unit admission.
Methods:
This was a retrospective cohort study of patients with cancer with unplanned intensive care unit admission from January 2017 to December 2018. We developed models to analyze the relative importance of well-known predictors of mortality in patients with cancer admitted to the intensive care unit compared with mortality at 28, 90, and 360 days after intensive care unit admission, both in the full cohort and stratified by the type of cancer when the patient was admitted to the intensive care unit.
Results:
Among 3,592 patients, 3,136 (87.3%) had solid tumors, and metastatic disease was observed in 60.8% of those patients. A total of 1,196 (33.3%), 1,738 (48.4%), and 2,435 patients (67.8%) died at 28, 90, and 360 days, respectively. An impaired functional status was the greatest contribution to mortality in the short term for all patients and in the short and long term for the subgroups of patients with solid tumors. For patients with hematologic malignancies, the use of mechanical ventilation was the most important variable associated with mortality in all study periods. The SOFA score at admission was important for mortality prediction only for patients with solid metastatic tumors and hematological malignancies. The use of vasopressors and renal replacement therapy had a small importance in predicting mortality at every time point analyzed after the SOFA score was accounted for.
Conclusion:
Healthcare providers must consider performance status, the use of mechanical ventilation, and the severity of illness when discussing prognosis, preferences for care, and end-of-life care planning with patients or their families during intensive care unit stays.
Views94Abstract
ORIGINAL ARTICLEDifferences in the relative importance of predictors of short- and long-term mortality among critically ill patients with cancer
Critical Care Science. 2024;36:e20240149en
11-11-2024DOI 10.62675/2965-2774.20240149-en
- Carla Marchini Dias da Silva ,
- Bárbara Beltrame Bettim ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Antônio Paulo Nassar Junior
Views94See moreABSTRACT
Objective:
To identify the relative importance of several clinical variables present at intensive care unit admission on the short- and long-term mortality of critically ill patients with cancer after unplanned intensive care unit admission.
Methods:
This was a retrospective cohort study of patients with cancer with unplanned intensive care unit admission from January 2017 to December 2018. We developed models to analyze the relative importance of well-known predictors of mortality in patients with cancer admitted to the intensive care unit compared with mortality at 28, 90, and 360 days after intensive care unit admission, both in the full cohort and stratified by the type of cancer when the patient was admitted to the intensive care unit.
Results:
Among 3,592 patients, 3,136 (87.3%) had solid tumors, and metastatic disease was observed in 60.8% of those patients. A total of 1,196 (33.3%), 1,738 (48.4%), and 2,435 patients (67.8%) died at 28, 90, and 360 days, respectively. An impaired functional status was the greatest contribution to mortality in the short term for all patients and in the short and long term for the subgroups of patients with solid tumors. For patients with hematologic malignancies, the use of mechanical ventilation was the most important variable associated with mortality in all study periods. The SOFA score at admission was important for mortality prediction only for patients with solid metastatic tumors and hematological malignancies. The use of vasopressors and renal replacement therapy had a small importance in predicting mortality at every time point analyzed after the SOFA score was accounted for.
Conclusion:
Healthcare providers must consider performance status, the use of mechanical ventilation, and the severity of illness when discussing prognosis, preferences for care, and end-of-life care planning with patients or their families during intensive care unit stays.
- Carla Marchini Dias da Silva
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ORIGINAL ARTICLE
Analyzing how the components of the SOFA score change over time in their contribution to mortality
- Barbara D. Lam ,
- Tristan Struja ,
- Yanran Li ,
- João Matos ,
- Ziyue Chen , [ ... ],
- Jesse Raffa
10-31-2024
Abstract
ORIGINAL ARTICLEAnalyzing how the components of the SOFA score change over time in their contribution to mortality
Critical Care Science. 2024;36:e20240030en
10-31-2024DOI 10.62675/2965-2774.20240030-en
- Barbara D. Lam ,
- Tristan Struja ,
- Yanran Li ,
- João Matos ,
- Ziyue Chen ,
- Xiaoli Liu ,
- Leo Anthony Celi ,
- Yugang Jia ,
- Jesse Raffa
Views110ABSTRACT
Objective:
Determine how each organ component of the SOFA score differs in its contribution to mortality risk and how that contribution may change over time.
Methods:
We performed multivariate logistic regression analysis to assess the contribution of each organ component to mortality risk on Days 1 and 7 of an intensive care unit stay. We used data from two publicly available datasets, eICU Collaborative Research Database (eICU-CRD) (208 hospitals) and Medical Information Mart for Intensive Care IV (MIMIC-IV) (1 hospital). The odds ratio of each SOFA component that contributed to mortality was calculated. Mortality was defined as death either in the intensive care unit or within 72 hours of discharge from the intensive care unit.
Results:
A total of 7,871 intensive care unit stays from eICU-CRD and 4,926 intensive care unit stays from MIMIC-IV were included. Liver dysfunction was most predictive of mortality on Day 1 in both cohorts (OR 1.3; 95%CI 1.2 - 1.4; OR 1.3; 95%CI 1.2 - 1.4, respectively). In the eICU-CRD cohort, central nervous system dysfunction was most predictive of mortality on Day 7 (OR 1.4; 95%CI 1.4 - 1.5). In the MIMIC-IV cohort, respiratory dysfunction (OR 1.4; 95%CI 1.3 - 1.5) and cardiovascular dysfunction (OR 1.4; 95%CI 1.3 - 1.5) were most predictive of mortality on Day 7.
Conclusion:
The SOFA score may be an oversimplification of how dysfunction of different organ systems contributes to mortality over time. Further research at a more granular timescale is needed to explore how the SOFA score can evolve and be ameliorated.
Keywords:Central nervous systemsHospitalsintensive care unitsLiverLogistic modelsmortalityOrgan dysfunction scoresPatient dischargeSee moreViews110Abstract
ORIGINAL ARTICLEAnalyzing how the components of the SOFA score change over time in their contribution to mortality
Critical Care Science. 2024;36:e20240030en
10-31-2024DOI 10.62675/2965-2774.20240030-en
- Barbara D. Lam ,
- Tristan Struja ,
- Yanran Li ,
- João Matos ,
- Ziyue Chen ,
- Xiaoli Liu ,
- Leo Anthony Celi ,
- Yugang Jia ,
- Jesse Raffa
Views110ABSTRACT
Objective:
Determine how each organ component of the SOFA score differs in its contribution to mortality risk and how that contribution may change over time.
Methods:
We performed multivariate logistic regression analysis to assess the contribution of each organ component to mortality risk on Days 1 and 7 of an intensive care unit stay. We used data from two publicly available datasets, eICU Collaborative Research Database (eICU-CRD) (208 hospitals) and Medical Information Mart for Intensive Care IV (MIMIC-IV) (1 hospital). The odds ratio of each SOFA component that contributed to mortality was calculated. Mortality was defined as death either in the intensive care unit or within 72 hours of discharge from the intensive care unit.
Results:
A total of 7,871 intensive care unit stays from eICU-CRD and 4,926 intensive care unit stays from MIMIC-IV were included. Liver dysfunction was most predictive of mortality on Day 1 in both cohorts (OR 1.3; 95%CI 1.2 - 1.4; OR 1.3; 95%CI 1.2 - 1.4, respectively). In the eICU-CRD cohort, central nervous system dysfunction was most predictive of mortality on Day 7 (OR 1.4; 95%CI 1.4 - 1.5). In the MIMIC-IV cohort, respiratory dysfunction (OR 1.4; 95%CI 1.3 - 1.5) and cardiovascular dysfunction (OR 1.4; 95%CI 1.3 - 1.5) were most predictive of mortality on Day 7.
Conclusion:
The SOFA score may be an oversimplification of how dysfunction of different organ systems contributes to mortality over time. Further research at a more granular timescale is needed to explore how the SOFA score can evolve and be ameliorated.
Keywords:Central nervous systemsHospitalsintensive care unitsLiverLogistic modelsmortalityOrgan dysfunction scoresPatient dischargeSee more
- Barbara D. Lam
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ORIGINAL ARTICLE
Advancing insights in critical COVID-19: unraveling lymphopenia through propensity score matching – Findings from the Multicenter LYMPH-COVID Study
- José Pedro Cidade ,
- Vicente Cês Souza-Dantas ,
- Rafaela Braga Mamfrim,
- Renata Carnevale Miranda,
- Henrique Tommasi Caroli, [ ... ],
- Pedro Póvoa
09-18-2024
Abstract
ORIGINAL ARTICLEAdvancing insights in critical COVID-19: unraveling lymphopenia through propensity score matching – Findings from the Multicenter LYMPH-COVID Study
Critical Care Science. 2024;36:e20240236en
09-18-2024DOI 10.62675/2965-2774.20240236-en
- José Pedro Cidade ,
- Vicente Cês Souza-Dantas ,
- Rafaela Braga Mamfrim,
- Renata Carnevale Miranda,
- Henrique Tommasi Caroli,
- Natália Almeida Oliveira,
- Alessandra e Figueiredo Thompson ,
- Gabriela E. Oliveira,
- Pedro Póvoa
Views69ABSTRACT
Objective
To elucidate the impact of lymphopenia on critical COVID-19 patient outcomes.
Methods
We conducted a multicenter prospective cohort study across five hospitals in Portugal and Brazil from 2020 to 2021. The study included adult patients admitted to the intensive care unit with SARS-CoV-2 pneumonia. Patients were categorized into two groups based on their lymphocyte counts within 48 hours of intensive care unit admission: the Lymphopenia Group (lymphocyte serum count < 1 × 109/L) and the Nonlymphopenia Group. Multivariate logistic regression, propensity score matching, Kaplan‒Meier survival curve analysis and Cox proportional hazards regression analysis were used.
Results
A total of 912 patients were enrolled, with 191 (20.9%) in the Nonlymphopenia Group and 721 (79.1%) in the Lymphopenia Group. Lymphopenia patients displayed significantly elevated disease severity indices, including Sequential Organ Failure Assessment and Simplified Acute Physiology Score 3 scores, at intensive care unit admission (p = 0.001 and p < 0.001, respectively). Additionally, they presented heightened requirements for vasopressor support (p = 0.045) and prolonged intensive care unit and in-hospital stays (both p < 0.001). Multivariate logistic regression analysis after propensity score matching revealed a significant contribution of lymphopenia to mortality, with an odds ratio of 1,621 (95%CI: 1,275 - 2,048; p < 0.001). Interaction models revealed an increase of 8% in mortality for each decade of longevity in patients with concomitant lymphopenia. In the subanalysis utilizing three-group stratification, the Severe Lymphopenia Group had the highest mortality rate, not only in direct comparisons but also in Kaplan‒Meier survival analysis (log-rank test p = 0.0048).
Conclusion
Lymphopenia in COVID-19 patients is associated with increased disease severity and an increased risk of mortality, underscoring the need for prompt support for critically ill high-risk patients. These findings offer important insights into improving patient care strategies for COVID-19 patients.
Keywords:Coronavirus infectionsCOVID-19critical careintensive care unitsLymphopeniamortalitySARS-CoV-2See moreViews69Abstract
ORIGINAL ARTICLEAdvancing insights in critical COVID-19: unraveling lymphopenia through propensity score matching – Findings from the Multicenter LYMPH-COVID Study
Critical Care Science. 2024;36:e20240236en
09-18-2024DOI 10.62675/2965-2774.20240236-en
- José Pedro Cidade ,
- Vicente Cês Souza-Dantas ,
- Rafaela Braga Mamfrim,
- Renata Carnevale Miranda,
- Henrique Tommasi Caroli,
- Natália Almeida Oliveira,
- Alessandra e Figueiredo Thompson ,
- Gabriela E. Oliveira,
- Pedro Póvoa
Views69ABSTRACT
Objective
To elucidate the impact of lymphopenia on critical COVID-19 patient outcomes.
Methods
We conducted a multicenter prospective cohort study across five hospitals in Portugal and Brazil from 2020 to 2021. The study included adult patients admitted to the intensive care unit with SARS-CoV-2 pneumonia. Patients were categorized into two groups based on their lymphocyte counts within 48 hours of intensive care unit admission: the Lymphopenia Group (lymphocyte serum count < 1 × 109/L) and the Nonlymphopenia Group. Multivariate logistic regression, propensity score matching, Kaplan‒Meier survival curve analysis and Cox proportional hazards regression analysis were used.
Results
A total of 912 patients were enrolled, with 191 (20.9%) in the Nonlymphopenia Group and 721 (79.1%) in the Lymphopenia Group. Lymphopenia patients displayed significantly elevated disease severity indices, including Sequential Organ Failure Assessment and Simplified Acute Physiology Score 3 scores, at intensive care unit admission (p = 0.001 and p < 0.001, respectively). Additionally, they presented heightened requirements for vasopressor support (p = 0.045) and prolonged intensive care unit and in-hospital stays (both p < 0.001). Multivariate logistic regression analysis after propensity score matching revealed a significant contribution of lymphopenia to mortality, with an odds ratio of 1,621 (95%CI: 1,275 - 2,048; p < 0.001). Interaction models revealed an increase of 8% in mortality for each decade of longevity in patients with concomitant lymphopenia. In the subanalysis utilizing three-group stratification, the Severe Lymphopenia Group had the highest mortality rate, not only in direct comparisons but also in Kaplan‒Meier survival analysis (log-rank test p = 0.0048).
Conclusion
Lymphopenia in COVID-19 patients is associated with increased disease severity and an increased risk of mortality, underscoring the need for prompt support for critically ill high-risk patients. These findings offer important insights into improving patient care strategies for COVID-19 patients.
Keywords:Coronavirus infectionsCOVID-19critical careintensive care unitsLymphopeniamortalitySARS-CoV-2See more
- José Pedro Cidade
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ORIGINAL ARTICLE
Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19
- Luísa Helena Machado Martinato ,
- Débora Schmidt ,
- Taila Cristina Piva ,
- Gracieli Nadalon Deponti ,
- Maricene Colissi Graboski , [ ... ],
- Graciele Sbruzzi
06-19-2024
Abstract
ORIGINAL ARTICLEInfluence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19
Critical Care Science. 2024;36:e20240253en
06-19-2024DOI 10.62675/2965-2774.20240253-en
- Luísa Helena Machado Martinato ,
- Débora Schmidt ,
- Taila Cristina Piva ,
- Gracieli Nadalon Deponti ,
- Maricene Colissi Graboski ,
- Rodrigo Della Méa Plentz ,
- Graciele Sbruzzi
Views69ABSTRACT
Objective
To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.
Methods
This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.
Results
Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).
Conclusion
Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.
Keywords:Coronavirus infectionsCOVID-19intensive care unitsmortalityObesityRehabilitationRespiration, artificialSARS-CoV-2See moreViews69Abstract
ORIGINAL ARTICLEInfluence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19
Critical Care Science. 2024;36:e20240253en
06-19-2024DOI 10.62675/2965-2774.20240253-en
- Luísa Helena Machado Martinato ,
- Débora Schmidt ,
- Taila Cristina Piva ,
- Gracieli Nadalon Deponti ,
- Maricene Colissi Graboski ,
- Rodrigo Della Méa Plentz ,
- Graciele Sbruzzi
Views69ABSTRACT
Objective
To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.
Methods
This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.
Results
Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).
Conclusion
Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.
Keywords:Coronavirus infectionsCOVID-19intensive care unitsmortalityObesityRehabilitationRespiration, artificialSARS-CoV-2See more
- Luísa Helena Machado Martinato
mortality Archives - Critical Care Science (CCS)
