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. 2021 Jan 6;9(1):2.
doi: 10.1186/s40560-020-00513-9.

Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018

Lowell Ling  1 , Chun Ming Ho  2 , Pauline Yeung Ng  3   4 , King Chung Kenny Chan  2 , Hoi Ping Shum  5 , Cheuk Yan Chan  5 , Alwin Wai Tak Yeung  6 , Wai Tat Wong  7 , Shek Yin Au  8 , Kit Hung Anne Leung  8 , Jacky Ka Hing Chan  9 , Chi Keung Ching  9 , Oi Yan Tam  10 , Hin Hung Tsang  10 , Ting Liong  11 , Kin Ip Law  11 , Manimala Dharmangadan  12   13 , Dominic So  12   13 , Fu Loi Chow  14 , Wai Ming Chan  4 , Koon Ngai Lam  15 , Kai Man Chan  16 , Oi Fung Mok  17 , Man Yee To  17 , Sze Yuen Yau  17 , Carmen Chan  17 , Ella Lei  17 , Gavin Matthew Joynt  7
Affiliations

Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018

Lowell Ling et al. J Intensive Care. .

Abstract

Background: Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong.

Methods: This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed.

Results: From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by - 0.15 (95% CI - 0.18 to - 0.11) per year (Pearson's R = - 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer-Lemeshow test p < 0.001).

Conclusions: Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.

Keywords: APACHE IV; Benchmarking; Hong Kong; Intensive care; Standard mortality ratio.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cohort identification
Fig. 2
Fig. 2
Trend in ICU admissions with APACHE IV SMR. This graph shows increasing ICU admissions per 10,000 population but decreasing APACHE IV SMR from 2008 to 2018. APACHE, Acute Physiology and Chronic Health Evaluation; SMR, standardised mortality ratio
Fig. 3
Fig. 3
Calibration of APACHE IV on hospital mortality prediction. The reference bold line shows perfect calibration between APACHE IV predicted hospital mortality and hospital mortality. The blue points represent observed hospital mortality. Observed mortality was lower than predicted mortality across the spectrum of illness severity in Hong Kong publicly funded intensive care units
See this image and copyright information in PMC

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