Mortality Trends Across Key Diagnostic Groups in Australian and New Zealand ICUs Over the Past 30 Years

doi:10.1097/CCM.0000000000006817

. 2025 Aug 14.

doi: 10.1097/CCM.0000000000006817. Online ahead of print.

Mortality Trends Across Key Diagnostic Groups in Australian and New Zealand ICUs Over the Past 30 Years

Julia K Pilowsky^{1

2}, Ryo Ueno^{3

4}, Josh McLarty^{3

5

6}, David Pilcher^{3

6

7}, Michael Bailey³, Alastair Brown^{3

4

8

9}

Affiliations

¹ School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
² Intensive Care NSW, NSW Agency for Clinical Innovation, Sydney, NSW, Australia.
³ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
⁵ Department of Intensive Care, Barwon Health, Geelong, VIC, Australia.
⁶ Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia.
⁷ Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society (ANZICS), Prahran, VIC, Australia.
⁸ Department of Critical Care Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
⁹ Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.

PMID: 40810586
DOI: 10.1097/CCM.0000000000006817

Mortality Trends Across Key Diagnostic Groups in Australian and New Zealand ICUs Over the Past 30 Years

Julia K Pilowsky et al. Crit Care Med. 2025.

. 2025 Aug 14.

doi: 10.1097/CCM.0000000000006817. Online ahead of print.

Authors

Julia K Pilowsky^{1

2}, Ryo Ueno^{3

4}, Josh McLarty^{3

5

6}, David Pilcher^{3

6

7}, Michael Bailey³, Alastair Brown^{3

4

8

9}

Affiliations

¹ School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
² Intensive Care NSW, NSW Agency for Clinical Innovation, Sydney, NSW, Australia.
³ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
⁵ Department of Intensive Care, Barwon Health, Geelong, VIC, Australia.
⁶ Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia.
⁷ Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society (ANZICS), Prahran, VIC, Australia.
⁸ Department of Critical Care Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
⁹ Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.

PMID: 40810586
DOI: 10.1097/CCM.0000000000006817

Abstract

Objectives: The Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) has been operational for 3 decades. It is important to understand how mortality outcomes have changed across diagnostic groups over time to facilitate the planning of future healthcare resources. We evaluated the trends in risk-adjusted mortality for ICU patients over the last 30 years.

Design: A retrospective cohort study.

Setting: All ICUs in Australia and New Zealand that contributed data to the ANZICS APD from January 1993 to December 2022.

Patients: Adult patients (≥ 16 yr) admitted to Australian and New Zealand ICUs.

Interventions: None.

Measurements and main results: The final cohort included 2,838,654 patients from 209 ICUs. Compared with the first decade patients admitted during the final decade of the study were older (60.0 yr [18.2 yr] vs. 62.0 yr [17.8 yr]), more often had a least one major comorbidity (23.2% vs. 25.2%), and had higher Acute Physiology and Chronic Health Evaluation III scores (45.6 [28.1] vs. 50.9 [24.1]). The five diagnostic groups with the highest mortality rates were cardiac arrest (53.6%), stroke and intracranial hemorrhage (34.8%), subarachnoid hemorrhage (21.2%), pneumonia (19.2%), and sepsis (19%). Risk-adjusted mortality decreased until 2010 but then plateaued. Cardiac arrest saw the greatest improvement in risk-adjusted mortality between the third vs. first study decades (odds ratio [OR], 0.82 [0.81-0.83]), while pneumonia saw the least (OR, 0.87 [0.87-0.88]). The pattern of improvement for most diagnostic groups were similar; however, mortality from stroke and intracranial hemorrhage continued to improve, whereas mortality from cardiac arrest appears to have increased over the past 10 years.

Conclusions: There have been substantial improvements in risk-adjusted mortality among ICU patients over the past 30 years; however, this improvement has plateaued recently. The reasons for this plateau warrant further investigation.

Keywords: adults; critical care; mortality.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

References

1. Salluh JIF, Chiche JD, Reis CE, et al.: New perspectives to improve critical care benchmarking. Ann Intensive Care 2018; 8:17
1. Moran JL, Bristow P, Solomon PJ, et al.; Australian and New Zealand Intensive Care Society Database Management Committee (ADMC): Mortality and length-of-stay outcomes, 1993–2003, in the binational Australian and New Zealand intensive care adult patient database. Crit Care Med 2008; 36:46–61
1. Zimmerman JE, Kramer AA, Knaus WA: Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 2013; 17:R81
1. Hutchings A, Durand MA, Grieve R, et al.: Evaluation of modernisation of adult critical care services in England: Time series and cost effectiveness analysis. BMJ 2009; 339:b4353
1. Esteban A, Frutos-Vivar F, Muriel A, et al.: Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188:220–230

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[1] Salluh JIF, Chiche JD, Reis CE, et al.: New perspectives to improve critical care benchmarking. Ann Intensive Care 2018; 8:17

[2] Salluh JIF, Chiche JD, Reis CE, et al.: New perspectives to improve critical care benchmarking. Ann Intensive Care 2018; 8:17

[3] Moran JL, Bristow P, Solomon PJ, et al.; Australian and New Zealand Intensive Care Society Database Management Committee (ADMC): Mortality and length-of-stay outcomes, 1993–2003, in the binational Australian and New Zealand intensive care adult patient database. Crit Care Med 2008; 36:46–61

[4] Moran JL, Bristow P, Solomon PJ, et al.; Australian and New Zealand Intensive Care Society Database Management Committee (ADMC): Mortality and length-of-stay outcomes, 1993–2003, in the binational Australian and New Zealand intensive care adult patient database. Crit Care Med 2008; 36:46–61

[5] Zimmerman JE, Kramer AA, Knaus WA: Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 2013; 17:R81

[6] Zimmerman JE, Kramer AA, Knaus WA: Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 2013; 17:R81

[7] Hutchings A, Durand MA, Grieve R, et al.: Evaluation of modernisation of adult critical care services in England: Time series and cost effectiveness analysis. BMJ 2009; 339:b4353

[8] Hutchings A, Durand MA, Grieve R, et al.: Evaluation of modernisation of adult critical care services in England: Time series and cost effectiveness analysis. BMJ 2009; 339:b4353

[9] Esteban A, Frutos-Vivar F, Muriel A, et al.: Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188:220–230

[10] Esteban A, Frutos-Vivar F, Muriel A, et al.: Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188:220–230

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Mortality Trends Across Key Diagnostic Groups in Australian and New Zealand ICUs Over the Past 30 Years

Affiliations

Mortality Trends Across Key Diagnostic Groups in Australian and New Zealand ICUs Over the Past 30 Years

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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