Severity of illness and risk of death associated with pulmonary artery catheter use.
OBJECTIVE
To examine the association between the use of the pulmonary artery catheter and mortality rate in critically ill patients with a higher vs. a lower severity of illness.


METHODS
Observational cohort study.


METHODS
A tertiary care university teaching hospital from March 1988 to March 1998.


METHODS
A total of 7,310 critically ill adult patients.


METHODS
None.


RESULTS
The main outcome measure was hospital mortality rate, controlled by multivariable logistic regression within four patient groups based on severity of illness. Cutoffs for severity of illness were chosen based on Acute Physiology and Chronic Health Evaluation (APACHE) II score 25th percentiles. Logistic regression analysis demonstrated no increased risk of death associated with exposure to the pulmonary artery catheter in the population as a whole. The associated odds ratio of hospital death for the entire cohort was 1.05 (95% confidence interval, 0.92-1.21). Subgroup analysis of severity of illness revealed the highest risk of death to be associated with the lowest APACHE II score quartile vs. a decreased associated mortality rate with the highest APACHE II score quartile after adjustment with multivariable logistic regression (APACHE II <18: odds ratio, 2.47, 95% confidence interval, 1.27-4.81; APACHE II 18-24: odds ratio, 1.64, 95% confidence interval, 1.24-2.17; APACHE II 25-31: odds ratio, 1.00, 95% confidence interval, 0.80-1.24; APACHE II >31: odds ratio, 0.80, 95% confidence interval, 0.64-1.00).


CONCLUSIONS
The use of the pulmonary artery catheter may decrease mortality rate in the most severely ill while increasing it in a population with a lower severity of illness. These findings underscore the necessity of examining the effect of severity of illness in future randomized controlled trials.
Chittock
Dean R
DR
Program of Critical Care Medicine, University of British Columbia, Vancouver Hospital & Health Sciences Centre, Vancouver, BC, Canada.
Dhingra
Vinay K
VK
Ronco
Juan J
JJ
Russell
James A
JA
Forrest
Dave M
DM
Tweeddale
Martin
M
Fenwick
John C
JC
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D002407:Catheterization, Swan-Ganz / Q000401:mortality*; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis