Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit
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Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. / Vincent, Jean-Louis; Marshall, John C; Namendys-Silva, Silvio A; François, Bruno; Martin-Loeches, Ignacio; Lipman, Jeffrey; Reinhart, Konrad; Antonelli, Massimo; Pickkers, Peter; Njimi, Hassane; Jimenez, Edgar; Sakr, Yasser; ICON investigators.
In: Lancet Respir Med, Vol. 2, No. 5, 01.05.2014, p. 380-386.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit
AU - Vincent, Jean-Louis
AU - Marshall, John C
AU - Namendys-Silva, Silvio A
AU - François, Bruno
AU - Martin-Loeches, Ignacio
AU - Lipman, Jeffrey
AU - Reinhart, Konrad
AU - Antonelli, Massimo
AU - Pickkers, Peter
AU - Njimi, Hassane
AU - Jimenez, Edgar
AU - Sakr, Yasser
AU - ICON investigators
N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.
PY - 2014/5/1
Y1 - 2014/5/1
N2 - BACKGROUND: Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality.METHODS: 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country.FINDINGS: 10,069 patients were included from ICUs in Europe (5445 patients; 54·1%), Asia (1928; 19·2%), the Americas (1723; 17·1%), Oceania (439; 4·4%), the Middle East (393; 3·9%), and Africa (141; 1·4%). Overall, 2973 patients (29·5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16·2% (95% CI 15·5-16·9) across the whole population and 25·8% (24·2-27·4) in patients with sepsis. Hospital mortality rates were 22·4% (21·6-23·2) in the whole population and 35·3% (33·5-37·1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0·19, p=0·002) and between-hospital variations (var=0·43, p<0·0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income.INTERPRETATION: This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death.FUNDING: None.
AB - BACKGROUND: Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality.METHODS: 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country.FINDINGS: 10,069 patients were included from ICUs in Europe (5445 patients; 54·1%), Asia (1928; 19·2%), the Americas (1723; 17·1%), Oceania (439; 4·4%), the Middle East (393; 3·9%), and Africa (141; 1·4%). Overall, 2973 patients (29·5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16·2% (95% CI 15·5-16·9) across the whole population and 25·8% (24·2-27·4) in patients with sepsis. Hospital mortality rates were 22·4% (21·6-23·2) in the whole population and 35·3% (33·5-37·1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0·19, p=0·002) and between-hospital variations (var=0·43, p<0·0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income.INTERPRETATION: This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death.FUNDING: None.
KW - Cohort Studies
KW - Comorbidity
KW - Critical Illness
KW - Global Health
KW - Hospital Mortality
KW - Humans
KW - Intensive Care Units
KW - Medical Audit
KW - Outcome Assessment (Health Care)
KW - Sepsis
U2 - 10.1016/S2213-2600(14)70061-X
DO - 10.1016/S2213-2600(14)70061-X
M3 - SCORING: Journal article
C2 - 24740011
VL - 2
SP - 380
EP - 386
JO - LANCET RESP MED
JF - LANCET RESP MED
SN - 2213-2600
IS - 5
ER -