Young Adults Among Patients Admitted to Polish Intensive Care Units in the Silesian ICU Registry

Epidemiology and clinical characteristics of patients discharged from the ICU in a vegetative or minimally conscious state

PURPOSE

A significant percentage of patients are discharged from intensive care units (ICU) with disorders of counciousness (DoC). The aim of this retrospective, case-control study was to compare patients discharged from the ICU in a vegetative state (VS) or minimally conscious state (MCS) and the rest of ICU survivors, and to identify independent predictors of DoC among ICU survivors.

METHODS

Data from 14,368 adult ICU survivors identified in a Silesian Registry of Intensive Care Units (active in the Silesian Region of Poland between October 2010 and December 2019) were analyzed. Patients discharged from the ICU in a VS or MCS were compared to the remaining ICU survivors. Pre-admission and admission variables that independently influence ICU discharge with DoC were identified.

RESULTS

Among the 14,368 analyzed adult ICU survivors, 1,064 (7.4%) were discharged from the ICU in a VS or MCS. The percentage of patients discharged from the ICU with DoC was similar in all age groups. Compared to non- DoC ICU patients, they had a higher mean APACHE II and SAPS III score at admission. Independent variables affecting ICU discharge with DoC included unconsciousness at ICU admission, cardiac arrest and craniocerebral trauma as primary cause of ICU admission, as well as a history of previous chronic neurological disorders and cerebral stroke (p<0.001).

CONCLUSION

Discharge in a VS and MCS was relatively frequent among ICU survivors. Discharge with DoC was more likely among patients who were unconscious at admission and admitted to the ICU due to cardiac arrest or craniocerebral trauma.

Intensive Care Unit Admissions During the First 3 Months of the COVID-19 Pandemic in Poland: A Single-Center, Cross-Sectional Study

Background

Data on the outcomes of patients with coronavirus disease 2019 (COVID-19) requiring Intensive Care Unit (ICU) care in Poland are limited. There are no data on critically ill patients with COVID-19 who did not meet criteria for ICU admission.

Material/Methods

We analyzed patients admitted to the ICU and those ineligible for ICU admission in a large COVID-19-dedicated hospital, during the first 3 months of the pandemic in Poland. Data from 67 patients considered for ICU admissions due to COVID-19 infection, treated between 10 March and 10 June 2020, were reviewed. Following exclusions, data on 32 patients admitted to the ICU and 21 patients ineligible for ICU admission were analyzed.

Results

In 38% of analyzed patients, symptoms of COVID-19 infection occurred during a hospital stay for an unrelated medical issue. The mean age of ICU patients was 62.4 (10.4) years, and the majority of patients were male (69%), with at least one comorbidity (88%). The mean admission APACHE II and SAPS II scores were 20.1 (8.1) points and 51.2 (15.3) points, respectively. The Charlson Comorbidity Index and Clinical Frailty Scale were lower in ICU patients compared with those disqualified: 5.9 (4.3) vs. 9.1 (3.5) points, P=0.01, and 4.7 (1.7) vs. 6.9 (1.2) points, P<0.01, respectively. All ICU patients required intubation and mechanical ventilation. ICU mortality was 67%. Hospital mortality among patients admitted to the ICU and those who were disqualified was 70% and 79%, respectively.

Conclusions

Patients with COVID-19 requiring ICU admission in our studied population were frail and had significant comorbidities. The outcomes in this group were poor and did not seem to be influenced by ICU admission.

Readmissions to General ICUs in a Geographic Area of Poland Are Seemingly Associated with Better Outcomes

BACKGROUND

Various factors can contribute to high mortality rates in intensive care units (ICUs). Here, we intended to define a population of patients readmitted to general ICUs in Poland and to identify independent predictors of ICU readmission.

METHODS

Data derived from adult ICU admissions from the Silesian region of Poland were analyzed. First-time ICU readmissions (≤30 days from ICU discharge after index admissions) were compared with first-time ICU admissions. Pre-admission and admission variables that independently influenced the need for ICU readmission were identified.

RESULTS

Among the 21,495 ICU admissions, 839 were first-time readmissions (3.9%). Patients readmitted to the ICU had lower mean APACHE II (21.2 ± 8.0 vs. 23.2 ± 8.8, p < 0.001) and TISS-28 scores (33.7 ± 7.4 vs. 35.2 ± 7.8, p < 0.001) in the initial 24 h following ICU admission, compared to first-time admissions. ICU readmissions were associated with lower mortality vs. first-time admissions (39.2% vs. 44.3%, p = 0.004). Independent predictors for ICU readmission included the admission from a surgical ward (among admission sources), chronic respiratory failure, cachexia, previous stroke, chronic neurological diseases (among co-morbidities), and multiple trauma or infection (among primary reasons for ICU admission).

CONCLUSIONS

High mortality associated with first-time ICU admissions is associated with a lower mortality rate during ICU readmissions.