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Erschienen in:

01.11.2003 | Original

Decisions to forgo life-sustaining therapy in ICU patients independently predict hospital death

verfasst von: Élie Azoulay, Frédéric Pochard, Maité Garrouste-Orgeas, Delphine Moreau, Laurent Montesino, Christophe Adrie, Arnaud de Lassence, Yves Cohen, Jean-François Timsit, on the behalf of the Outcomerea Study Group

Erschienen in: Intensive Care Medicine | Ausgabe 11/2003

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Abstract

Objective

More than one-half the deaths of patients admitted to intensive care units (ICUs) occur after a decision to forgo life-sustaining therapy (DFLST). Although DFLSTs typically occur in patients with severe comorbidities and intractable acute medical disorders, other factors may influence the likelihood of DFLSTs. The objectives of this study were to describe the factors and mortality associated with DFLSTs and to evaluate the potential independent impact of DFLSTs on hospital mortality.

Design and setting

Prospective multicenter 2-year study in six ICUs in France.

Patients

The 1,698 patients admitted to the participating ICUs during the study period, including 295 (17.4%) with DFLSTs.

Measurements and results

The impact of DFLSTs on hospital mortality was evaluated using a model that incorporates changes in daily logistic organ dysfunction scores during the first ICU week. Univariate predictors of death included demographic factors (age, gender), comorbidities, reasons for ICU admission, severity scores at ICU admission, and DFLSTs. In a stepwise Cox model five variables independently predicted mortality: good chronic health status (hazard ratio, 0.479), SAPS II score higher than 39 (2.05), chronic liver disease (1.463), daily logistic organ dysfunction score (1.357 per point), and DFLSTs (1.887).

Conclusions

DFLSTs remain independently associated with death after adjusting on comorbidities and severity at ICU admission and within the first ICU week. This highlights the need for further clarifying the many determinants of DFLSTs and for routinely collecting DFLSTs in studies with survival as the outcome variable of interest.

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Titel: Decisions to forgo life-sustaining therapy in ICU patients independently predict hospital death
verfasst von: Élie Azoulay
Frédéric Pochard
Maité Garrouste-Orgeas
Delphine Moreau
Laurent Montesino
Christophe Adrie
Arnaud de Lassence
Yves Cohen
Jean-François Timsit
on the behalf of the Outcomerea Study Group
Publikationsdatum: 01.11.2003
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 11/2003
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-1989-3

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Decisions to forgo life-sustaining therapy in ICU patients independently predict hospital death