Predictors of Adverse Outcome Early After ICU Discharge

Abstract

Objective: Clinicians are often confronted with the timely discharge decision, in order to avoid readmission and escalation of costs. Aim of the present study was to determine potential risk factors for ICU readmission or death early after ICU discharge. Methods: One hundred fifty-four ICU discharged patients were divided into three outcome groups according to whether they were readmitted (Group A, n = 13), or died within 72 h after ICU discharge (Group B, n = 11), or were not readmitted or died within 72 h (Group C, n = 130). Results: Patients being readmitted to the ICU had significantly longer prior length of stay in a ward compared to the group with positive outcome after ICU discharge (median: 12 vs. 2 days, p = 0.023). Patients with early post discharge death had received vasopressor support with norepinephrine for significantly longer period of time and were significantly more severely diseased at the day of discharge, based on APACHE II calculation. Rates of tracheostomy, central venous catheter, nasogastric nutrition and colonization with an MDR organism, along with hemodynamic and respiratory parameters at ICU discharge were similar among the outcome groups. Nonetheless, the prevalence of patients with Glasgow Coma Scale (GCS) < 13 was significantly higher in Group B. The principal cause of ICU readmission was sepsis (8/13 patients), whereas of early mortality was acute respiratory failure (9/11 patients). Conclusions: Patients with higher disease severity at discharge and moderately altered mental status, especially those with prolonged hospitalization and vasopressor support are at increased risk for ICU readmission or early post discharge mortality.