Causes of death and determinants of outcome in critically ill patients.
BACKGROUND
Whereas most studies focus on laboratory and clinical research, little is known about the causes of death and risk factors for death in critically ill patients.


METHODS
Three thousand seven hundred patients admitted to an adult intensive care unit (ICU) were prospectively evaluated. Study endpoints were to evaluate causes of death and risk factors for death in the ICU, in the hospital after discharge from ICU, and within one year after ICU admission. Causes of death in the ICU were defined according to standard ICU practice, whereas deaths in the hospital and at one year were defined and grouped according to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) score. Stepwise logistic regression analyses were separately calculated to identify independent risk factors for death during the given time periods.


RESULTS
Acute, refractory multiple organ dysfunction syndrome was the most frequent cause of death in the ICU (47%), and central nervous system failure (relative risk [RR] 16.07, 95% confidence interval [CI] 8.3 to 31.4, p < 0.001) and cardiovascular failure (RR 11.83, 95% CI 5.2 to 27.1, p < 0.001) were the two most important risk factors for death in the ICU. Malignant tumour disease and exacerbation of chronic cardiovascular disease were the most frequent causes of death in the hospital (31.3% and 19.4%, respectively) and at one year (33.2% and 16.1%, respectively).


CONCLUSIONS
In this primarily surgical critically ill patient population, acute or chronic multiple organ dysfunction syndrome prevailed over single-organ failure or unexpected cardiac arrest as a cause of death in the ICU. Malignant tumour disease and chronic cardiovascular disease were the most important causes of death after ICU discharge.
Mayr
Viktoria D
VD
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. viktoria.mayr@uibk.ac.at
Dünser
Martin W
MW
Greil
Veronika
V
Jochberger
Stefan
S
Luckner
Günter
G
Ulmer
Hanno
H
Friesenecker
Barbara E
BE
Takala
Jukka
J
Hasibeder
Walter R
WR
D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome