title: Infection as an independent risk factor for mortality in the surgical intensive care unit.
abstract: OBJECTIVE
  Medical and surgical intensive care unit patients represent two different populations and require different treatment approaches. The aim of this study was to investigate the parameters associated with mortality in medical and surgical intensive care units.
  
  
  METHODS
  This was a prospective cohort study of adult patients admitted to a medical and surgical intensive care unit teaching hospital over an 11-month period. Factors associated with mortality were explored using logistic regression analysis.
  
  
  RESULTS
  In total, 827 admissions were observed, and 525 patients >18 years old and with a length of stay >24 h were analyzed. Of these patients, 227 were in the medical and 298 were in the surgical intensive care unit. The surgical patients were older (p<0.01) and had shorter lengths of stay (p<0.01). The mortality in the intensive care unit (35.1 vs. 26.2, p = 0.02) and hospital (48.8 vs. 35.5, p<0.01) was higher for medical patients. For patients in the surgical intensive care unit, death was independently associated with the need for mechanical ventilation, prognostic score (SAPS II), community-acquired infection, nosocomial infection, and intensive care unit-acquired infection. For patients in the medical intensive care unit, death was independently associated with the need for mechanical ventilation and prognostic score.
  
  
  CONCLUSIONS
  Although the presence of infection is associated with a high mortality in both the medical and surgical intensive care units, the results of this prospective study suggest that infection has a greater impact in patients admitted to the surgical intensive care unit. Measures and trials to prevent and treat sepsis may be most effective in the surgical intensive care unit population.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração (InCor), Pulmonary Division, São PauloSP, Brazil.
authors.forename: Carlos
authors.initials: C
authors.lastname: Toufen
authors.forename: Suelene Aires
authors.initials: SA
authors.lastname: Franca
authors.forename: Valdelis N
authors.initials: VN
authors.lastname: Okamoto
authors.forename: João Marcos
authors.initials: JM
authors.lastname: Salge
authors.forename: Carlos Roberto Ribeiro
authors.initials: CR
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003422:Critical Care / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
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