title: Depression as an independent risk factor for mortality in critically ill patients.
abstract: OBJECTIVE
  Mortality on medical intensive care units (ICU) is approximately 25%. It is associated with age, severity of illness, and comorbidities. Preexisting depression is a risk factor for worse outcome in many diseases. The impact of depression on outcome of ICU patients has not been investigated. We assessed a possible association between mortality and preexisting depressive mood at the time of ICU admission. The primary end point was 28-day mortality.
  
  
  METHODS
  This single-center cohort study was conducted in a tertiary medical ICU. Two hundred patients were evaluated for preexisting depressive mood at ICU admission, determined by Hospital Anxiety and Depression Scale (HADS) score ≥8 in the depression dimension in patients with appropriate cognitive function. Patients with insufficient cognitive function were assessed using observer rating by next of kin by Hammond scale (cutoff ≥4) and/or a modified version of the Hospital Anxiety and Depression Scale for observer rating (cutoff ≥10).
  
  
  RESULTS
  In total, 66 (33%) of 200 patients were classified with preexisting depressive mood. Forty-nine (24.5%) of 200 patients had died by day 28. Of these, 23 (47%) had preexisting depressive mood as compared with 43 of 151 (29%) 28-day survivors (p = .017). Multiple logistic regression analysis revealed that preexisting depressive mood at the time of ICU admission is an independent risk factor for 28-day (odds ratio = 2.2, 95% confidence interval = 1.08-4.5, p = .030) and in-hospital mortality (median time till death = 20.5 [2-186] days, odds ratio = 2.58, 95% confidence interval = 1.31-5.1, p = .006).
  
  
  CONCLUSIONS
  Preexisting depressive mood might be an independent risk factor for 28-day mortality in medical ICU patients. This could have diagnostic and therapeutic implications for critically ill patients.
authors: From the Department of Medicine III (Wewalka, Warszawska, Strunz, Kitzberger, Holzinger, Fuhrmann, Zauner, Miehsler, Moser), Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; and Department of Medicine (Miehsler), Hospital Barmherzige Brüder, Salzburg, Austria.
authors: Marlene
authors: M
authors: Wewalka
authors: Joanna
authors: J
authors: Warszawska
authors: Volker
authors: V
authors: Strunz
authors: Reinhard
authors: R
authors: Kitzberger
authors: Ulrike
authors: U
authors: Holzinger
authors: Valentin
authors: V
authors: Fuhrmann
authors: Christian
authors: C
authors: Zauner
authors: Wolfgang
authors: W
authors: Miehsler
authors: Gabriele
authors: G
authors: Moser
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality* / Q000523:psychology; D003863:Depression / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents