title: Intensive care acquired infection is an independent risk factor for hospital mortality: a prospective cohort study.
abstract: BACKGROUND
  The aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality.
  
  
  METHODS
  Patients with a longer than 48 hour stay in a mixed 10 bed ICU in a tertiary-level teaching hospital were prospectively enrolled between May 2002 and June 2003. Risk factors for hospital mortality were analyzed with a logistic regression model.
  
  
  RESULTS
  Of 335 patients, 80 developed ICU-acquired infection. Among the patients with ICU-acquired infections, hospital mortality was always higher, regardless of whether or not the patients had had infection on admission (infection on admission group (IAG), 35.6% versus 17%, p = 0.008; and no-IAG, 25.7% versus 6.1%, p = 0.023). In IAG (n = 251), hospital stay was also longer in the presence of ICU-acquired infection (median 31 versus 16 days, p < 0.001), whereas in no-IAG (n = 84), hospital stay was almost identical with and without the presence of ICU-acquired infection (18 versus 17 days). In univariate analysis, the significant risk factors for hospital mortality were: Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, sequential organ failure assessment (SOFA) score >8, ICU-acquired infection, age > or = 65, community-acquired pneumonia, malignancy or immunosuppressive medication, and ICU length of stay >5 days. In multivariate logistic regression analysis, ICU-acquired infection remained an independent risk factor for hospital mortality after adjustment for APACHE II score and age (odds ratio (OR) 4.0 (95% confidence interval (CI): 2.0-7.9)) and SOFA score and age (OR 2.7 (95% CI: 2.9-7.6)).
  
  
  CONCLUSIONS
  ICU-acquired infection was an independent risk factor for hospital mortality even after adjustment for the APACHE II or SOFA scores and age.
authors.affiliation: Department of Infection Control, Oulu University Hospital, FIN-90029 OYS, Finland. pekka.ylipalosaari@oulu.fi
authors.forename: Pekka
authors.initials: P
authors.lastname: Ylipalosaari
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
authors.forename: Jouko
authors.initials: J
authors.lastname: Laurila
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.forename: Hannu
authors.initials: H
authors.lastname: Syrjälä
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors