The effects of performance status one week before hospital admission on the outcomes of critically ill patients.
OBJECTIVE
To assess the impact of performance status (PS) impairment 1 week before hospital admission on the outcomes in patients admitted to intensive care units (ICU).


METHODS
Retrospective cohort study in 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We classified PS impairment according to the Eastern Cooperative Oncology Group (ECOG) scale in absent/minor (PS = 0-1), moderate (PS = 2) or severe (PS = 3-4). We used univariate and multivariate logistic regression analyses to investigate the association between PS impairment and hospital mortality.


RESULTS
PS impairment was moderate in 17.3 % and severe in 6.9 % of patients. The hospital mortality was 14.4 %. Overall, the worse the PS, the higher the ICU and hospital mortality and length of stay. In addition, patients with worse PS were less frequently discharged home. PS impairment was associated with worse outcomes in all SAPS 3, Charlson Comorbidity Index and age quartiles as well as according to the admission type. Adjusting for other relevant clinical characteristics, PS impairment was associated with higher hospital mortality (odds-ratio (OR) = 1.96 (95 % CI 1.63-2.35), for moderate and OR = 4.22 (3.32-5.35), for severe impairment). The effects of PS on the outcome were particularly relevant in the medium range of severity-of-illness. These results were consistent in the subgroup analyses. However, adding PS impairment to the SAPS 3 score improved only slightly its discriminative capability.


CONCLUSIONS
PS impairment was associated with worse outcomes independently of other markers of chronic health status, particularly for patients in the medium range of severity of illness.
Research Institute, Hospital do Coração (HCor), São Paulo, Brazil.|Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Fernando G
FG
Zampieri
Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil.|Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brazil.
Fernando A
FA
Bozza
Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil.|Intensive Care Unit, Hospital Estadual Getúlio Vargas, Rio de Janeiro, Brazil.
Giulliana M
GM
Moralez
Intensive Care Unit, Hospital São Luiz-Unidade Jabaquara, São Paulo, Brazil.
Débora D S
DD
Mazza
Intensive Care Unit, Hospital Israelita Albert Sabin, Rio de Janeiro, Brazil.
Alexandre V
AV
Scotti
Intensive Care Unit, Hospital Barra D'Or, Rio de Janeiro, Brazil.
Marcelo S
MS
Santino
Intensive Care Unit, Hospital Anchieta, Taguatinga, Brazil.
Rubens A B
RA
Ribeiro
Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
Edison M
EM
Rodrigues Filho
Intensive Care Unit, Hospital São Marcos, Recife, Brazil.
Maurício M
MM
Cabral
Intensive Care Unit, Hospital Santa Luzia, Brasília, Brazil.
Marcelo O
MO
Maia
Intensive Care Unit, Clínica São Vicente, Rio de Janeiro, Brazil.
Patrícia S
PS
D'Alessandro
Intensive Care Unit, Hospital Bangu, Rio de Janeiro, Brazil.
Sandro V
SV
Oliveira
Intensive Care Unit, Hospital Oeste D'Or, Rio de Janeiro, Brazil.
Márcia A M
MA
Menezes
Intensive Care Unit, Hospital Unimed Vitória, Vitória, Brazil.
Eliana B
EB
Caser
Intensive Care Unit, Hospital Municipal Souza Aguiar, Rio de Janeiro, Brazil.
Roberto S
RS
Lannes
Intensive Care Unit, Hospital Regional do Cariri, Juazeiro do Norte, Brazil.
Meton S
MS
Alencar Neto
Intensive Care Unit, Hospital Agenor Paiva, Salvador, Brazil.
Maristela M
MM
Machado
Intensive Care Unit, Santa Casa de Caridade de Diamantina, Diamantina, Brazil.
Marcelo F
MF
Sousa
Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil.|Postgraduate Program of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Jorge I F
JI
Salluh
Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil. marciosoaresms@gmail.com.|Postgraduate Program of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. marciosoaresms@gmail.com.
Marcio
M
Soares
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
Critical care; Markers of baseline health status; Outcomes; Performance status
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