Prevalence and long-term outcomes of patients with life-limiting illness admitted to intensive care units in Australia and New Zealand.

Author(s)
Wagner, Kate
Orford, Neil
Milnes, Sharyn
Secombe, Paul
Philpot, Steve
Pilcher, David
Publication Date
2024-06-22
Abstract
Determine the prevalence and outcomes of patients with life-limiting illness (LLI) admitted to Australian and New Zealand Intensive Care Units (ICUs).Retrospective registry-linked observational cohort study of all adults admitted to Australian and New Zealand ICUs from 1st January 2018 until 31st December 2020 (New Zealand) and 31st March 2022 (Australia), recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database.The primary outcome was 1-year mortality. Secondary outcomes included ICU and hospital mortality, ICU and hospital length of stay, and 4-year survival.A total of 566,260 patients were included, of whom 129,613 (22.9%) had one or more LLI. Mortality at one year was 28.1% in those with LLI and 10.4% in those without LLI (p < 0.001). Mortality in intensive care (6.8% v 3.4%, p < 0.001), hospital (11.8% v 5.0%, p < 0.001), and at two (36.6% v 14.1%, p < 0.001), three (43.7% v 17.7%, p < 0.001) and four (55.6% v 24.5%, p < 0.001) years were all higher in the cohort of patients with LLI. Patients with LLI had a longer ICU (1.9 [0.9, 3.7] v 1.6 [0.9, 2.9] days, p < 0.001) and hospital length of stay (8.8 [49,16.0] v 7.2 [3.9, 12.9] days, p < 0.001), and were more commonly readmitted to ICU during the same hospitalisation than patients without LLI (5.2% v 3.7%, p < 0.001). After multivariate analysis the LLI with the strongest adverse effect on survival was frailty (HR 2.08, 95% CI 2.03 to 2.12, p < 0.001), followed by the presence of metastatic cancer (HR 1.97, 95% CI 1.92 to 2.02, p < 0.001), and chronic liver disease (HR 1.65, 95% CI 1.65 to 1.71, p < 0.001).Patients with LLI account for almost a quarter of ICU admissions in Australia and New Zealand, require prolonged ICU and hospital care, and have high mortality in subsequent years. This knowledge should be used to identify this vulnerable cohort of patients, and to ensure that treatment is aligned to each patient's values and realistic goals.
Affiliation
Cabrini Hospital, Malvern, VIC, Australia.
University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
School of Medicine, Deakin University, Geelong, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine (SPHPM), Monash University, Melbourne, VIC, Australia.
Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
School of Medicine, Deakin University, Geelong, VIC, Australia.
Alice Springs Hospital, Alice Springs, NT, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Cabrini Hospital, Malvern, VIC, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Department of Intensive Care, Alfred Health, Commercial Road, Prahran 3004, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine (SPHPM), Monash University, Melbourne, VIC, Australia.
Department of Intensive Care, Alfred Health, Commercial Road, Prahran 3004, VIC, Australia.
Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resources Evaluation, 101 High Street, Prahran, VIC 3004, Australia.
Citation
Crit Care Resusc . 2024 Jun 22;26(2):116-122. doi: 10.1016/j.ccrj.2024.02.001. eCollection 2024 Jun.
ISSN
1441-2772
OrcId
Pubmed ID
https://pubmed.ncbi.nlm.nih.gov/39072231/?otool=iaurydwlib
Link
Subject
End-of-life
Intensive care
Life-limiting illness
Long-term outcomes
MESH subject
Title
Prevalence and long-term outcomes of patients with life-limiting illness admitted to intensive care units in Australia and New Zealand.
Type of document
Journal Article
Entity Type
Publication

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