Trend in outcome of critically ill patients with co-morbidity: a 15-year study

Introduction

Critically ill patients with underlying co-morbidity have a high hospital mortality rate. This study describes the trend in the severity-adjusted mortality of such patients over a 15-year period.

Methods

We used the Acute Physiology and Chronic Health Evaluation (APACHE) III database of our institution to identify patients with solid tumors, hematology malignancy, and hepatic cirrhosis. We categorized the 15-year study period into three 5-year groups. We calculated the standardized mortality ratio (SMR) with the 95% confidence interval (CI) for each co-morbidity.

Results

During the study period, there were 73,626 ICU admissions; 92.6% white, 56.1% male, mean age 62.7 years, and 17.7% with co-morbidities. The overall mortality rate of the study population was 10.2%: 7% for patients with no co-morbidity, 21.1% for solid tumors, 25.7% for hematology malignancy, and 29.2% for hepatic cirrhosis. The predicted mortality rates were 9.9% for patients with no co-morbidity, 25.6% for solid tumors, 27.6% for hematology malignancy, and 35.7% for hepatic cirrhosis. The SMR (95%) CI for patients without co-morbidity was 0.71 (0.66 to 0.75), 0.83 (0.79 to 0.87), and 0.62 (0.59 to 0.65) for the first, second, and third 5-year periods, respectively. The SMR (95%) CI for the each co-morbidity is presented in Table 1.

Table 1 SMR, 95% CI for each co-morbidity

Conclusions

The severity-adjusted hospital mortality of critically ill patients with hematology malignancy and hepatic cirrhosis has improved over the past 15 years.