Introduction
Materials and methods
Data source
Participants
Variables
Management of missing data
Statistical analysis
Results
Subjects and baseline characteristics
Variables | Survivors (n = 19,040) | Non-survivors (n = 3828) | p | SMD |
---|---|---|---|---|
Sex, male (%) | 9653 (50.7%) | 1947 (50.9%) | 0.890 | 0.011 |
Age (years) | 64 ± 18 | 70 ± 16 | < 0.001 | 0.354 |
Ethnicity (%) | 0.910 | 0.026 | ||
African American | 1887 (9.9%) | 395 (10.3%) | ||
Asian | 365 (1.9%) | 73 (1.9%) | ||
Caucasian | 14,760 (77.5%) | 2954 (77.2%) | ||
Hispanic | 757 (4.0%) | 163 (4.3%) | ||
Native American | 170 (0.9%) | 31 (0.8%) | ||
Other/unknown | 1101 (5.8%) | 212 (5.4%) | ||
Admission height (cm) | 168.3 ± 14.3 | 167.8 ± 15.7 | 0.066 | 0.032 |
Admission weight (kg) | 83.0 ± 28.5 | 79.0 ± 27.5 | < 0.001 | 0.143 |
Source of infection (%) | < 0.001 | 0.276 | ||
GI | 2264 (11.9%) | 579 (15.1%) | ||
Cutaneous/soft tissue | 1684 (8.8%) | 219 (5.7%) | ||
Gynecologic | 65 (0.3%) | 10 (0.3%) | ||
Other | 1192 (6.3%) | 308 (8.0%) | ||
Pulmonary | 7110 (37.3%) | 1641 (42.9%) | ||
renal/UTI (including bladder) | 4621 (24.3%) | 591 (15.4%) | ||
unknown | 2104 (11.1%) | 480 (12.5%) | ||
Admitting source (%) | < 0.001 | 0.226 | ||
Operating room | 55 (0.3%) | 4 (0.1%) | ||
Recovery room | 35 (0.2%) | 4 (0.1%) | ||
Chest pain center | 3 (0.0%) | 0 (0.0%) | ||
Floor | 3854 (20.2%) | 1097 (28.7%) | ||
Other ICU | 131 (0.7%) | 40 (1.0%) | ||
Other hospital | 377 (2.0%) | 110 (2.9%) | ||
Direct admit | 1115 (5.9%) | 236 (6.2%) | ||
Emergency department | 13,470 (70.7%) | 2337 (61.1%) | ||
Unit type (%) | < 0.001 | 0.100 | ||
CCU-CTICU | 1119 (5.9%) | 220 (5.7%) | ||
CSICU | 312 (1.6%) | 67 (1.8%) | ||
CTICU | 126 (0.7%) | 36 (0.9%) | ||
Cardiac ICU | 1094 (5.7%) | 253 (6.6%) | ||
MICU | 2475 (13.0%) | 593 (15.5%) | ||
Med-Surg ICU | 12,836 (67.4%) | 2434 (63.6%) | ||
Neuro ICU | 346 (1.8%) | 87 (2.3%) | ||
SICU | 732 (3.8%) | 138 (3.6%) | ||
Use of mechanical ventilation (%) | 3807 (20.0) | 1641 (42.9) | < 0.001 | 0.508 |
GCS (median [IQR]) | 14 [10, 15] | 10 [7, 14] | < 0.001 | 0.673 |
Bilirubin (mg/dl) | 2.21 ± 2.46 | 2.85 ± 3.57 | < 0.001 | 0.210 |
Creatinine (mg/dl) | 1.89 ± 1.81 | 2.39 ± 1.72 | < 0.001 | 0.285 |
Platelet (×109/L) | 197.15 ± 107.79 | 171.60 ± 113.49 | < 0.001 | 0.231 |
PaO2 (mmHg) | 93 ± 47 | 91 ± 53 | 0.132 | 0.025 |
Mean blood pressure (mmHg) | 60 ± 16 | 50 ± 18 | < 0.001 | 0.575 |
SOFA (median [IQR]) | 7 [6, 9] | 10 [8, 12] | < 0.001 | 0.823 |
SOFA-respiratory (median [IQR]) | 2 [1, 3] | 2 [2, 3] | < 0.001 | 0.420 |
SOFA-GSC (median [IQR]) | 1 [0, 2] | 2 [1, 3] | < 0.001 | 0.668 |
SOFA-circulation (median [IQR]) | 2 [2, 2] | 2 [2, 2] | < 0.001 | 0.159 |
SOFA-liver (median [IQR]) | 1 [0, 2] | 1 [0, 2] | < 0.001 | 0.203 |
SOFA-coagulation (median [IQR]) | 0 [0, 1] | 0 [0, 2] | < 0.001 | 0.351 |
SOFA-renal (median [IQR]) | 1 [0, 2] | 2 [0, 2] | < 0.001 | 0.417 |
Dialysis (%) | 947 (5.0%) | 251 (6.6%) | < 0.001 | 0.068 |
Urine output (ml/24 h) (median [IQR]) | 1344 [642, 2380] | 622 [176, 1232] | < 0.001 | 0.526 |
WBC (×109/L) (median [IQR]) | 13.10 [8.3, 18.9] | 14.80 [7.8, 22.2] | < 0.001 | 0.191 |
Temperature (°C) (median [IQR]) | 36.6 [36.2, 36.9] | 36.4 [35.8, 36.8] | < 0.001 | 0.275 |
Respiratory rate (/min) (median [IQR]) | 31 [14, 38] | 34 [27, 41] | < 0.001 | 0.233 |
Sodium (mmol/l) | 137.99 ± 6.37 | 138.30 ± 7.58 | 0.007 | 0.045 |
Heart rate (/min) (median [IQR]) | 112 [98, 127] | 120 [103, 137] | < 0.001 | 0.221 |
pH (mean ± SD) | 7.36 ± 0.10 | 7.30 ± 0.14 | < 0.001 | 0.537 |
Hematocrit (%) | 31.0 ± 6.2 | 30.1 ± 7.0 | < 0.001 | 0.149 |
Albumin (mg/dl) | 2.53 ± 0.60 | 2.26 ± 0.62 | < 0.001 | 0.448 |
PaCO2 (mmHg) | 39.51 ± 12.69 | 39.71 ± 15.27 | 0.387 | 0.014 |
BUN (mg/dl) | 33.24 ± 24.97 | 45.65 ± 28.71 | < 0.001 | 0.461 |
Glucose (mg/dl) | 162.80 ± 102.59 | 164.53 ± 111.84 | 0.349 | 0.016 |
AIDS (%) | 53 (0.3%) | 16 (0.4%) | 0.202 | 0.024 |
Hepatic failure (%) | 344 (1.8%) | 150 (3.9%) | < 0.001 | 0.127 |
Lymphoma (%) | 172 (0.9%) | 53 (1.4%) | 0.008 | 0.045 |
Metastatic cancer (%) | 567 (3.0%) | 233 (6.1%) | < 0.001 | 0.150 |
Leukemia (%) | 255 (1.3%) | 100 (2.6%) | < 0.001 | 0.092 |
Immunosuppression (%) | 1004 (5.3%) | 297 (7.8%) | < 0.001 | 0.101 |
Cirrhosis (%) | 443 (2.3%) | 207 (5.4%) | < 0.001 | 0.160 |
Latent growth mixture modeling
Number of classes | Log likelihood | AIC | BIC | SABIC | Entropy | %class1 | %class2 | %class3 | %class4 | %class5 | %class6 |
---|---|---|---|---|---|---|---|---|---|---|---|
1 | − 205,674.3 | 411,356.6 | 411,388.8 | 411,376.0 | 1.0000000 | 100.000000 | |||||
2 | − 194,289.6 | 388,595.2 | 388,659.5 | 388,634.1 | 0.7755563 | 21.147455 | 78.852545 | ||||
3 | −190,705.8 | 381,435.5 | 381,532.0 | 381,493.8 | 0.7120173 | 34.336190 | 58.649641 | 7.014168 | |||
4 | −189,735.3 | 379,502.6 | 379,631.2 | 379,580.4 | 0.6440044 | 3.961868 | 44.057198 | 12.663985 | 39.31695 | ||
5 | −189,328.7 | 378,697.3 | 378,858.1 | 378,794.5 | 0.5804752 | 22.787301 | 3.550813 | 51.670457 | 11.19468 | 10.796747 | |
6 | − 188,823.6 | 377,695.3 | 377,888.2 | 377,811.9 | 0.5931242 | 34.445513 | 7.154102 | 41.770159 | 10.10145 | 4.871436 | 1.657338 |
Persistent critical illness
Clinical outcomes | Class 1 (n = 5211) | Class 2 (n = 812) | Class 3 (n = 11,816) | Class 4 (n = 2560) | Class 5 (n = 2469) | p |
---|---|---|---|---|---|---|
The day on which acute variables no longer more predictive than antecedent variables | 16 | 27 | 6 | 7 | 8 | |
PCI, n (%) | 97 (1.9%) | 29 (3.6%) | 831 (7.0%) | 508 (19.8%) | 584 (23.7%) | < 0.001 |
Hospital discharge location (%) | < 0.001 | |||||
Unknown | 6 (0.1%) | 1 (0.1%) | 17 (0.1%) | 4 (0.2%) | 3 (0.1%) | |
Death | 949 (18.2%) | 568 (70.0%) | 796 (6.7%) | 497 (19.4%) | 1018 (41.2%) | |
Home | 1986 (38.1%) | 68 (8.4%) | 6360 (53.8%) | 897 (35.0%) | 533 (21.6%) | |
Nursing home | 83 (1.6%) | 8 (1.0%) | 245 (2.1%) | 52 (2.0%) | 40 (1.6%) | |
Other external | 440 (8.4%) | 46 (5.7%) | 692 (5.9%) | 211 (8.2%) | 243 (9.8%) | |
Other hospital | 335 (6.4%) | 41 (5.0%) | 527 (4.5%) | 159 (6.2%) | 151 (6.1%) | |
Rehabilitation | 192 (3.7%) | 27 (3.3%) | 405 (3.4%) | 112 (4.4%) | 72 (2.9%) | |
Skilled nursing facility | 1220 (23.4%) | 53 (6.5%) | 2774 (23.5%) | 628 (24.5%) | 409 (16.6%) | |
Unit discharge status, expired (%) | 603 (11.6%) | 485 (59.7%) | 332 (2.8%) | 277 (10.8%) | 719 (29.1%) | |
Length of stay in ICU (days) (median [IQR]) | 2 [1, 5] | 4 [1, 10] | 2 [1, 3] | 3 [2, 6] | 4 [1, 8] | < 0.001 |
Hospital discharge status, expired (%) | 949 (18.2%) | 568 (70.0%) | 796 (6.7%) | 497 (19.4%) | 1018 (41.2%) | < 0.001 |
Length of stay in hospital (days) (median [IQR]) | 7 [3, 12] | 5 [2, 14] | 6 [4, 9] | 7 [4, 12] | 7 [3, 14] | < 0.001 |
Step function of time | Acute score | Antecedent score | ||
---|---|---|---|---|
HR (95% CI) | p | HR (95% CI) | p | |
0–48 h | 1.60 [1.55, 1.65] | < 0.001 | 1.29 [1.16, 1.44] | < 0.001 |
48–72 h | 2.10 [1.95, 2.26] | < 0.001 | 1.73 [1.41, 2.12] | < 0.001 |
72 h–7 days | 2.21 [2.10, 2.33] | < 0.001 | 1.93 [1.67, 2.24] | < 0.001 |
7 days–14 days | 1.54 [1.45, 1.64] | < 0.001 | 1.72 [1.45, 2.03] | < 0.001 |
14–21 days | 1.37 [1.23, 1.53] | < 0.001 | 2.38 [1.82, 3.13] | < 0.001 |
> 21 days | 1.26 [1.12, 1.42] | < 0.001 | 2.32 [1.77, 3.04] | < 0.001 |
Biochemical signature of PCI
Changes in urea-to-creatinine ratio, median (IQR) | Total (n = 17,945) | Non-PCI (n = 17,302) | PCI (n = 643) | p |
---|---|---|---|---|
Day 1 as reference | ||||
Day 2 | 0.1 (− 3.2, 3.49) | 0.09 (− 3.22, 3.5) | 0.37 (− 2.69, 3.27) | 0.287 |
Day 3 | 0.3 (− 4.43, 5.48) | 0.27 (− 4.45, 5.48) | 0.75 (− 3.73, 5.33) | 0.325 |
Day 4 | 0.64 (− 5, 7.28) | 0.58 (− 5.08, 7.21) | 1.28 (− 4.03, 8.55) | 0.018 |
Day 5 | 1.49 (− 4.78, 9.41) | 1.35 (− 4.92, 9.21) | 2.8 (− 3.93, 11.27) | 0.006 |
Day 6 | 2.54 (− 4.29, 11.37) | 2.35 (− 4.55, 11.16) | 3.99 (− 2.76, 12.64) | 0.008 |
Day 7 | 3.33 (− 3.74, 12.67) | 3.1 (− 4.07, 12.44) | 4.58 (− 2.52, 14.04) | 0.022 |
Day 8 | 4.31 (− 3.19, 14.55) | 3.91 (− 3.58, 14.08) | 5.9 (− 1.63, 15.77) | 0.005 |
Day 9 | 5.33 (− 2.95, 16.24) | 4.85 (− 3.59, 16.16) | 6.87 (− 1.93, 16.53) | 0.063 |
Day 10 | 5.85 (− 2.89, 16.75) | 5 (− 3.52, 16.06) | 7.07 (− 1.34, 18.16) | 0.003 |
Day 2 as reference | ||||
Day 3 | 0.11 (− 2.96, 3.17) | 0.07 (− 3.03, 3.15) | 0.69 (− 2.06, 3.39) | 0.007 |
Day 4 | 0.44 (− 3.99, 5.41) | 0.31 (− 4.14, 5.32) | 1.4 (− 2.38, 6.47) | < 0.001 |
Day 5 | 1.27 (− 4.19, 7.97) | 1.13 (− 4.38, 7.71) | 2.56 (−2.31, 10) | < 0.001 |
Day 6 | 2.14 (− 4.01, 9.96) | 1.85 (− 4.36, 9.59) | 3.86 (− 2.54, 11.58) | < 0.001 |
Day 7 | 2.98 (− 3.61, 11.39) | 2.73 (− 3.84, 11.07) | 3.9 (−2.2, 13.16) | 0.001 |
Day 8 | 3.98 (− 3.14, 13.21) | 3.44 (− 3.79, 12.5) | 5.64 (− 1.03, 14.39) | < 0.001 |
Day 9 | 4.99 (− 3.21, 15.09) | 4.4 (−4.02, 14.93) | 6.41 (−1.14, 15.82) | 0.007 |
Day 10 | 5.45 (− 2.7, 16) | 4.77 (−3.62, 15.4) | 6.95 (−0.55, 17.46) | < 0.001 |
Day 3 as reference | ||||
Day 4 | 0.27 (− 2.64, 3.2) | 0.21 (− 2.71, 3.1) | 0.85 (−1.74, 4.07) | < 0.001 |
Day 5 | 0.84 (− 3.26, 5.83) | 0.67 (− 3.45, 5.58) | 2 (− 1.83, 7.64) | < 0.001 |
Day 6 | 1.62 (− 3.57, 8.23) | 1.39 (− 3.85, 7.81) | 2.81 (−1.81, 9.98) | < 0.001 |
Day 7 | 2.41 (− 3.58, 10.23) | 2.14 (− 4, 9.86) | 3.52 (−1.76, 11.91) | < 0.001 |
Day 8 | 3.14 (− 3.19, 11.67) | 2.58 (− 3.61, 11.06) | 5.17 (−1.13, 13.55) | < 0.001 |
Day 9 | 4.23 (− 3.18, 13.65) | 3.56 (− 4, 13.23) | 5.53 (−1.1, 14.96) | 0.001 |
Day 10 | 4.76 (− 2.92, 14.61) | 3.91 (− 3.72, 13.65) | 6.51 (−1.19, 16.23) | < 0.001 |
Day 4 as reference | ||||
Day 5 | 0.55 (− 2.23, 3.64) | 0.46 (− 2.36, 3.57) | 1.12 (−1.37, 3.88) | < 0.001 |
Day 6 | 1.25 (− 2.96, 6.24) | 1.05 (− 3.21, 6.04) | 2.27 (−1.52, 7.27) | < 0.001 |
Day 7 | 1.95 (− 3.11, 8.29) | 1.67 (− 3.42, 8.04) | 2.86 (−1.97, 9.15) | 0.004 |
Day 8 | 2.83 (− 2.96, 10.18) | 2.44 (− 3.39, 9.8) | 4.26 (−1.55, 11.39) | < 0.001 |
Day 9 | 3.36 (− 3, 11.9) | 2.87 (−3.54, 11.57) | 4.44 (−1.54, 13.06) | 0.007 |
Day 10 | 4.19 (− 3.16, 13.54) | 3.38 (−3.82, 12.77) | 5.71 (−1.72, 14.76) | < 0.001 |
Day 5 as reference | ||||
Day 6 | 0.59 (− 2.11, 3.71) | 0.47 (− 2.24, 3.63) | 1.22 (− 1.36, 3.98) | < 0.001 |
Day 7 | 1.06 (− 2.87, 5.96) | 0.87 (− 3.13, 5.74) | 2 (− 1.82, 6.69) | 0.005 |
Day 8 | 1.88 (− 3.25, 8.04) | 1.43 (− 3.58, 7.75) | 3.11 (− 1.32, 8.47) | < 0.001 |
Day 9 | 2.6 (− 3.66, 9.87) | 1.93 (− 4.02, 9.57) | 3.88 (− 2.27, 10.42) | 0.008 |
Day 10 | 3.15 (− 3.78, 11.18) | 2.4 (− 4.32, 10.27) | 4.71 (− 2.95, 12.71) | < 0.001 |
Day 6 as reference | ||||
Day 7 | 0.46 (− 2.26, 3.56) | 0.38 (−2.38, 3.46) | 0.92 (− 1.54, 4.02) | 0.011 |
Day 8 | 1.04 (− 2.83, 5.68) | 0.7 (− 3.14, 5.41) | 1.88 (− 1.65, 6.61) | < 0.001 |
Day 9 | 1.75 (− 3.7, 8.13) | 1.21 (− 4.2, 7.71) | 2.52 (− 2.03, 8.77) | 0.002 |
Day 10 | 2.29 (− 4, 9.36) | 1.46 (− 4.81, 8.64) | 3.84 (− 2.28, 10.72) | < 0.001 |
Day 7 as reference | ||||
Day 8 | 0.51 (− 2.2, 3.51) | 0.32 (− 2.45, 3.33) | 1.05 (− 1.46, 3.98) | < 0.001 |
Day 9 | 1 (− 3.26, 5.82) | 0.69 (− 3.61, 5.7) | 1.72 (− 2.26, 6.07) | 0.009 |
Day 10 | 1.35 (− 3.48, 7.14) | 1.04 (− 4.14, 6.67) | 2.37 (− 2.32, 8.14) | < 0.001 |
Day 8 as reference | ||||
Day 9 | 0.44 (− 2.45, 3.57) | 0.23 (−2.65, 3.56) | 0.82 (− 1.99, 3.75) | 0.051 |
Day 10 | 0.66 (− 3.47, 5) | 0.31 (− 3.94, 4.73) | 1.49 (− 2.79, 5.38) | < 0.001 |
Day 9 vs 10 | 0.23 (− 2.53, 3.1) | 0.02 (− 3.08, 2.98) | 0.63 (− 1.73, 3.43) | < 0.001 |