title: In-hospital mortality and long-term survival of patients with acute intoxication admitted to the ICU.
abstract: OBJECTIVE
  To assess in-hospital and long-term mortality of Dutch ICU patients admitted with an acute intoxication.
  
  
  METHODS
  Cohort of ICU admissions from a national ICU registry linked to records from an insurance claims database.
  
  
  METHODS
  Eighty-one ICUs (85% of all Dutch ICUs).
  
  
  METHODS
  Seven thousand three hundred thirty-one admissions between January 1, 2008, and October 1, 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  Kaplan-Meier curves were used to compare the unadjusted mortality of the total intoxicated population and for specific intoxication subgroups based on the Acute Physiology and Chronic Health Evaluation IV reasons for admission: 1) alcohol(s), 2) analgesics, 3) antidepressants, 4) street drugs, 5) sedatives, 6) poisoning (carbon monoxide, arsenic, or cyanide), 7) other toxins, and 8) combinations. The case-mix adjusted mortality was assessed by the odds ratio adjusted for age, gender, severity of illness, intubation status, recurrent intoxication, and several comorbidities. The ICU mortality was 1.2%, and the in-hospital mortality was 2.1%. The mortality 1, 3, 6, 12, and 24 months after ICU admission was 2.8%, 4.1%, 5.2%, 6.5%, and 9.3%, respectively. Street drugs had the highest mortality 2 years after ICU admission (12.3%); a combination of different intoxications had the lowest (6.3%). The adjusted observed mortality showed that intoxications with street drugs and "other toxins" have a significant higher mortality 1 month after ICU admission (odds ratioadj = 1.63 and odds ratioadj= 1.73, respectively). Intoxications with alcohol or antidepressants have a significant lower mortality 1 month after ICU admission (odds ratioadj = 0.50 and odds ratioadj = 0.46, respectively). These differences were not found in the adjusted mortality 3 months upward of ICU admission.
  
  
  CONCLUSIONS
  Overall, the mortality 2 years after ICU admission is relatively low compared with other ICU admissions. The first 3 months after ICU admission there is a difference in mortality between the subgroups, not thereafter. Still, the difference between the in-hospital mortality and the mortality after 2 years is substantial.
authors.affiliation: 1Department of Intensive Care and Emergency Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands. 2Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 3National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands. 4Dutch National Poisons Information Center, University Medical Center, University of Utrecht, Utrecht, The Netherlands. 5Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands.
authors.forename: Raya
authors.initials: R
authors.lastname: Brandenburg
authors.forename: Sylvia
authors.initials: S
authors.lastname: Brinkman
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
authors.forename: Jan
authors.initials: J
authors.lastname: Meulenbelt
authors.forename: Dylan W
authors.initials: DW
authors.lastname: de Lange
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000435:Alcoholic Intoxication / Q000145:classification / Q000401:mortality*; D015331:Cohort Studies; D062787:Drug Overdose / Q000145:classification / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D017741:Survivors / Q000706:statistics & numerical data*