Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 31;28(1):287.
doi: 10.1186/s13054-024-05072-1.

Variability in forgoing life-sustaining treatment practices in critically Ill patients with hospital-acquired bloodstream infections: a secondary analysis of the EUROBACT-2 international cohort

Hannah Wozniak  1   2 , Alexis Tabah  3   4   5   6 , Jan J De Waele  7 , Jean-François Timsit  8   9 , Niccolò Buetti  10   11   12 ; EUROBACT-2 Study Group; European Society of Intensive Care Medicine (ESICM); European Society of Clinical Microbiology; Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP); OUTCOMEREA Network
Affiliations

Variability in forgoing life-sustaining treatment practices in critically Ill patients with hospital-acquired bloodstream infections: a secondary analysis of the EUROBACT-2 international cohort

Hannah Wozniak et al. Crit Care. .

Abstract

Background: The decision to forgo life-sustaining treatment in intensive care units (ICUs) is influenced by ethical, cultural, and medical factors. This study focuses on a population of patients with hospital-acquired bloodstream infections (HABSI) to investigate the association between patient, pathogen, center and country-level factors and these decisions.

Methods: We analyzed data from the EUROBACT-2 study (June 2019-January 2021) from 265 centers worldwide, focusing on non-COVID-19 patients who died in the hospital or within 28 days after HABSI. We assessed whether death was preceded by a decision to forgo life-sustaining treatment, examining country, center, patient, and pathogen variables. To assess the association of each potentially important variable with the decision to forgo life-sustaining treatment, univariable mixed logistic regression models with a random center effect were performed.

Results: Among 1589 non-COVID-19 patients, 519 (32.7%) died, with 191 (36.8%) following a decision to forgo life-sustaining treatment. Significant geographical differences were observed, with no reported decisions to forgo life-sustaining treatment in African countries and fewer in the Middle East compared to Western Europe, Australia, and Asia. Once a center effect was considered, only health expenditure (Odds ratio 1.79, 95%CI: 1.45-2.21, p < 0.01) and age (Odds ratio 1.02, 95%CI: 1.002-1.05, p = 0.03) were significantly associated with decisions to forgo life-sustaining treatment, while other patient and pathogen factors were not.

Conclusion: Economic and regional disparities significantly impact end-of-life decision-making in ICUs. Global policies should consider these disparities to ensure equitable end-of-life care practices.

PubMed Disclaimer

Conflict of interest statement

JDW has consulted for Roche Diagnostics, Menarini, MSD, Pfizer, ThermoFisher and Viatris (fees and honoraria paid to institution). JFT reported advisory boards participation for Merck, Gilead, Beckton-Dickinson, Pfizer, Shionogi, Roche diagnostic, Advanz Pharma, research grants from Merck, Pfizer, Thermofischer.

Figures

Fig. 1
Fig. 1
Proportion of hospital-acquired bloodstream infection mortality cases following a decision to forgo life-sustaining treatment. This map highlights the countries that reported Intensive Care Unit (ICU) deaths associated with Hospital-Acquired Bloodstream Infections (HABSI). The map displays the percentage of these deaths that occurred following a clinical decision to forgo life-sustaining treatment. Map created with Khαrtis (https://www.sciencespo.fr/cartographie/khartis/)
See this image and copyright information in PMC

References

    1. Vincent JL, Marshall JC, Ñamendys-Silva SA, François B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med. 2014;2(5):380–6. 10.1016/S2213-2600(14)70061-X - DOI - PubMed
    1. Avidan A, Sprung CL, Schefold JC, Ricou B, Hartog CS, Nates JL, et al. Variations in end-of-life practices in intensive care units worldwide (Ethicus-2): a prospective observational study. Lancet Respir Med. 2021;9(10):1101–10. 10.1016/S2213-2600(21)00261-7 - DOI - PubMed
    1. Lobo SM, De Simoni FHB, Jakob SM, Estella A, Vadi S, Bluethgen A, et al. Decision-making on withholding or withdrawing life support in the ICU: a worldwide perspective. Chest. 2017;152(2):321–9. 10.1016/j.chest.2017.04.176. 10.1016/j.chest.2017.04.176 - DOI - PubMed
    1. Azoulay É, Metnitz B, Sprung CL, Timsit JF, Lemaire F, Bauer P, et al. End-of-life practices in 282 intensive care units: data from the SAPS 3 database. Intensive Care Med. 2009;35(4):623–30. 10.1007/s00134-008-1310-6 - DOI - PubMed
    1. Quill CM, Ratcliffe SJ, Harhay MO, Halpern SD. Variation in decisions to forgo life-sustaining therapies in US ICUs. Chest. 2014;146(3):573–82. 10.1378/chest.13-2529 - DOI - PMC - PubMed

Publication types

LinkOut - more resources