Intensive Care Medicine

, 35:623 | Cite as

End-of-life practices in 282 intensive care units: data from the SAPS 3 database

  • Élie AzoulayEmail author
  • Barbara Metnitz
  • Charles L. Sprung
  • Jean-François Timsit
  • François Lemaire
  • Peter Bauer
  • Benoît Schlemmer
  • Rui Moreno
  • Philipp Metnitz
  • on behalf of the SAPS 3 investigators



To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database.


We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression.


DFLSTs occurred in 1,239 (8.6%) patients [677 (54.6%) withholding and 562 (45.4%) withdrawal decisions]. Hospital mortality was 21% (3,050/14,488); 36.2% (1,105) deaths occurred after DFLSTs. Across the participating ICUs, hospital mortality in patients with DFLSTs ranged from 80.3 to 95.4% and time from admission to decisions ranged from 2 to 4 days. Independent predictors of decisions to forgo LSTs included 13 variables associated with increased incidence of DFLSTs and 7 variables associated with decrease incidence of DFLST. Among hospital and ICU-related variables, a higher number of nurses per bed was associated with increased incidence of DFLST, while availability of an emergency department in the same hospital, presence of a full time ICU-specialist and doctors presence during nights and week-ends were associated with a decreased incidence of DFLST.


This large study identifies structural variables that are associated with substantial variations in the incidence and the characteristics of decisions to forgo life-sustaining therapies.


Intensive care End-of-life SAPS 3 Treatment withholding Treatment withdrawal 



Statistical analysis was supported by a grant from the Fund of the Austrian National Bank, Project # 10995 ONB. We thank the participants from all over the world who dedicated a significant amount of their time and effort to this project, proving that it is still possible to conduct a worldwide academic study. A complete list of participants is found in the web-site of the project (

Supplementary material

134_2008_1310_MOESM1_ESM.doc (96 kb)
Supplementary material (DOC 96 kb)


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Élie Azoulay
    • 1
    Email author
  • Barbara Metnitz
    • 2
  • Charles L. Sprung
    • 3
  • Jean-François Timsit
    • 4
    • 5
  • François Lemaire
    • 6
  • Peter Bauer
    • 2
  • Benoît Schlemmer
    • 1
  • Rui Moreno
    • 7
  • Philipp Metnitz
    • 8
  • on behalf of the SAPS 3 investigators
  1. 1.Service de Réanimation Médicale, Hôpital Saint-Louis et Université Paris 7, Assistance Publique, Hôpitaux de ParisParisFrance
  2. 2.Department of Medical StatisticsUniversity of ViennaViennaAustria
  3. 3.Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael
  4. 4.Medical ICUHôpital A. MichallonGrenoble cedex 9France
  5. 5.Team 11, Outcome of Cancer and Critical Illnesses. UJF-INSERM U823Centre de Recherche Institut Albert BonniotLa Tronche cedexFrance
  6. 6.Assistance Publique Hop de Paris, Hopital H. MondorParis 12 UniversityCréteilFrance
  7. 7.Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos CapuchosCentro Hospitalar de Lisboa Central E.P.ELisbonPortugal
  8. 8.Department of Anesthesiology and General Intensive CareUniversity Hospital of ViennaViennaAustria

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