title: Critical care admission for acute medical patients.
abstract: Demand for intensive care is growing. There are no contemporaneous consensus guidelines on which patients should be referred to intensive care. Prognostic scoring systems predict survival, but are of limited use for individual patients. Some groups of patients have historically been regarded as having a very high mortality after admission to intensive care, raising questions about the appropriateness of advanced organ support in these patients. We reviewed the existing literature on outcomes of patients admitted to intensive care with chronic obstructive pulmonary disease, liver cirrhosis and haematological malignancies. We identified specific markers indicating a poor prognosis in each group, and also identified common risk factors predicting a high mortality across all groups. Multiple organ failure at the time of referral to intensive care predicts a very poor outcome. Physical factors indicating a limited functional capacity also predict high mortality, suggesting that frailty has a significant impact on intensive care outcome.
authors.affiliation: Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Packham
authors.affiliation: Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK peter.hampshire@rlbuht.nhs.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Hampshire
mesh_terms: D000208:Acute Disease; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D011379:Prognosis; D012307:Risk Factors
keywords: Intensive care; chronic obstructive pulmonary disease; cirrhosis; frailty; haematological malignancies; prognostic scoring systems