Delayed admission to the ICU increases mortality in septic shock

Objective

To evaluate the association between delay in ICU admission and mortality in patients with septic shock, which is known to be higher in public hospitals.

Methods

A prospective cohort study of patients referred to the ICU of University Hospital – Londrina State University, from January to December 2005, including 574 patients, following access protocol to the ICU in chronological order. The main outcome analyzed was the hospital mortality rate. Delay in admission due to lack of an available bed for immediate admission was considered the exposure factor in bivariate analysis between the two groups of patients (delayed admission and immediate admission). We also evaluated APACHE II and SOFA scores.

Results

Among the 574 patients analyzed, 127 (22.1%) cases had septic shock as the admission diagnosis. Most of these patients with septic shock (66.9%) were in the group of delayed admission and more frequently they came from the emergency department (52.8%). There was no difference between the groups at bed solicitation related to age, sex, comorbidities, and SOFA and APACHE II scores. At admission, patients in the delayed admission group presented an increase in APACHE II and SOFA scores. They also had higher scores and nosocomial infection rates compared with the immediate admission group. Pneumonia was the most frequent site of infection in both groups. The hospital mortality rate was higher in the delayed admission group (82.4%) compared with the immediate admission group (64.3%) (P = 0.042), relative risk 1.28 (95% CI = 1.01 to 1.64; P = 0.042). Kaplan–Meier survival curves showed a tendency to lower survival rate for the delayed admission group (P = 0.05).

Conclusion

Delay in ICU admission results in increased risk of death in patients with septic shock. Higher APACHE II and SOFA scores of patients in the late admission group probably reflect clinical deterioration during the time delay.