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Observational Study
. 2013;68(8):1103-8.
doi: 10.6061/clinics/2013(08)07.

Infection as an independent risk factor for mortality in the surgical intensive care unit

Carlos Toufen Jr  1 , Suelene Aires Franca, Valdelis N Okamoto, João Marcos Salge, Carlos Roberto Ribeiro Carvalho
Affiliations
Observational Study

Infection as an independent risk factor for mortality in the surgical intensive care unit

Carlos Toufen Jr et al. Clinics (Sao Paulo). 2013.

Abstract

Objectives: Medical and surgical intensive care unit patients represent two different populations and require different treatment approaches. The aim of this study was to investigate the parameters associated with mortality in medical and surgical intensive care units.

Methods: This was a prospective cohort study of adult patients admitted to a medical and surgical intensive care unit teaching hospital over an 11-month period. Factors associated with mortality were explored using logistic regression analysis.

Results: In total, 827 admissions were observed, and 525 patients >18 years old and with a length of stay >24 h were analyzed. Of these patients, 227 were in the medical and 298 were in the surgical intensive care unit. The surgical patients were older (p<0.01) and had shorter lengths of stay (p<0.01). The mortality in the intensive care unit (35.1 vs. 26.2, p = 0.02) and hospital (48.8 vs. 35.5, p<0.01) was higher for medical patients. For patients in the surgical intensive care unit, death was independently associated with the need for mechanical ventilation, prognostic score (SAPS II), community-acquired infection, nosocomial infection, and intensive care unit-acquired infection. For patients in the medical intensive care unit, death was independently associated with the need for mechanical ventilation and prognostic score.

Conclusions: Although the presence of infection is associated with a high mortality in both the medical and surgical intensive care units, the results of this prospective study suggest that infection has a greater impact in patients admitted to the surgical intensive care unit. Measures and trials to prevent and treat sepsis may be most effective in the surgical intensive care unit population.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
The main reasons for 298 surgical intensive care unit (SICU) and 227 medical intensive care unit (MICU) admissions during the study period. Legend: Respiratory failure: admission due to respiratory failure; Sepsis: admission due to sepsis; Cardiovascular: admission due to cardiovascular reasons; Other clinic: admission due to another clinical reason; Other surgery: admission due to surgery other than abdominal surgery.
Figure 2
Figure 2
The mortality of SICU and MICU patients associated with community-, nosocomial-, and ICU-acquired infections in non-infected patients. Legend: MICU = medical ICU, SICU = surgical ICU, *p<0.01.
Figure 3
Figure 3
The Kaplan-Meyer survival curve for patients admitted to the surgical intensive care unit (A) and medical intensive care unit (B) stratified by infected and non-infected patients, and the Kaplan-Meyer survival curve for infected (C) and non-infected (D) patients stratified by intensive care unit type (surgical or medical).
See this image and copyright information in PMC

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