The effects of performance status one week before hospital admission on the outcomes of critically ill patients
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To assess the impact of performance status (PS) impairment 1 week before hospital admission on the outcomes in patients admitted to intensive care units (ICU).
Retrospective cohort study in 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We classified PS impairment according to the Eastern Cooperative Oncology Group (ECOG) scale in absent/minor (PS = 0–1), moderate (PS = 2) or severe (PS = 3–4). We used univariate and multivariate logistic regression analyses to investigate the association between PS impairment and hospital mortality.
PS impairment was moderate in 17.3 % and severe in 6.9 % of patients. The hospital mortality was 14.4 %. Overall, the worse the PS, the higher the ICU and hospital mortality and length of stay. In addition, patients with worse PS were less frequently discharged home. PS impairment was associated with worse outcomes in all SAPS 3, Charlson Comorbidity Index and age quartiles as well as according to the admission type. Adjusting for other relevant clinical characteristics, PS impairment was associated with higher hospital mortality (odds-ratio (OR) = 1.96 (95 % CI 1.63–2.35), for moderate and OR = 4.22 (3.32–5.35), for severe impairment). The effects of PS on the outcome were particularly relevant in the medium range of severity-of-illness. These results were consistent in the subgroup analyses. However, adding PS impairment to the SAPS 3 score improved only slightly its discriminative capability.
PS impairment was associated with worse outcomes independently of other markers of chronic health status, particularly for patients in the medium range of severity of illness.
KeywordsPerformance status Critical care Outcomes Markers of baseline health status
This study was supported by the National Council for Scientific and Technological Development (CNPq) (Grant No 304240/2014-1), Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ) and by departmental funds from the D’Or Institute for Research and Education.
Compliance with ethical standards
Conflicts of interest
Dr. Soares and Dr. Salluh are founders and equity shareholders of Epimed Solutions®, which markets the Epimed Monitor System®, a cloud-based software for ICU management and benchmarking. The other authors declare that they have no conflict of interest.
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