A prediction model for ‘ICU mortality or prolonged ICU stay’ in critically unwell patients with acute pancreatitis: insights from a 2003–2020 cohort analysis using the ANZICS-CORE database

Critical Care volume 29, Article number: 347, Published: 06 August 2025

Objective

Critically unwell patients with acute pancreatitis (AP) are at increased risk of mortality and prolonged ICU length of stay (LOS). We quantified the frequency, risk factors and complications of prolonged ICU LOS in a large cohort of critically unwell adult patients with AP and developed a model to predict a low-risk trajectory ‘survived ICU with ICU LOS ≤7 days’ versus a high-risk trajectory ‘ICU mortality or ICU LOS > 7 days’.

Methods

A retrospective cohort analysis of adult patients admitted to Australian and New Zealand ICUs with AP between 2003 and 2020 was conducted using the Australian and New Zealand Intensive Care Society Centre for Outcome Reporting and Evaluation database. Data was censored to December 2020 in order to pre-date the COVID-19 pandemic. The incidence, risk factors and outcomes related to prolonged ICU LOS in AP patients was reported. Multivariate logistic regression was used to build a prediction model for a low-risk versus high-risk outcome. Discrimination was performed with 10-fold cross validation and calibration plot analysis was reported.

Main results

13,275 patients met inclusion criteria; 60% were male, with a mean age 59±18, mean APACHE III 56±26. 2860 (21.6%) had an ICU LOS > 7 days, 1022 (7.7%) died in ICU, and 3557 (26.8%) had a high-risk trajectory. Prolonged ICU LOS was associated with increased ICU mortality (OR 1.57 95% CI 1.43–1.73 p < 0.001), hospital mortality (OR 1.69 95% CI 1.56–1.83 p < 0.001), and resource use: mechanical ventilation (OR 5.99 95% CI 5.21–6.90 p < 0.001), inotrope/vasopressor support (OR 3.27 95% CI 2.82–3.79 p < 0.001) and dialysis (OR 4.12 95% CI 3.63–4.68 p < 0.001). Model accuracy was 79.5%, Cohen K = 0.49 and AUROC 0.827. For a high-risk trajectory, sensitivity was 0.54 and specificity 0.916. APACHE III, PaO2:FiO2 ratio and early mechanical ventilation were the most influential covariates. Prolonged ICU LOS was associated with increased rate of hospital discharge to rehabilitation or a nursing home.

Conclusions

More than a quarter of ICU patients with AP have a high-risk trajectory. Prolonged ICU admissions are associated with significantly worse mortality and hospital outcomes, and increase resource use. Our prediction model, if confirmed in future studies, may present an opportunity for prognostic enrichment in patients with more severe disease.

 

Early intubation and patient-centered outcomes in septic shock: a secondary analysis of a prospective multicenter study

 

by Ricard Mellado-Artigas, Carlos Ferrando, Frédéric Martino, Agathe Delbove, Bruno L. Ferreyro, Cedric Darreau, Sophie Jacquier, Laurent Brochard and Nicolas Lerolle 

 

Critical Care volume 26, Article number: 163 (2022) Published: 07 June 2022

 

Purpose

Despite the benefits of mechanical ventilation, its use in critically ill patients is associated with complications and had led to the growth of noninvasive techniques. We assessed the effect of early intubation (first 8 h after vasopressor start) in septic shock patients, as compared to non-early intubated subjects (unexposed), regarding in-hospital mortality, intensive care and hospital length of stay.

Methods

This study involves secondary analysis of a multicenter prospective study. To adjust for baseline differences in potential confounders, propensity score matching was carried out. In-hospital mortality was analyzed in a time-to-event fashion, while length of stay was assessed as a median difference using bootstrapping.

Results

A total of 735 patients (137 intubated in the first 8 h) were evaluated. Propensity score matching identified 78 pairs with similar severity and characteristics on admission. Intubation was used in all patients in the early intubation group and in 27 (35%) subjects beyond 8 h in the unexposed group. Mortality occurred in 35 (45%) and in 26 (33%) subjects in the early intubation and unexposed groups (hazard ratio 1.44 95% CI 0.86–2.39, p = 0.16). ICU and hospital length of stay were not different among groups [9 vs. 5 (95% CI 1 to 7) and 14 vs. 16 (95% CI − 7 to 8) days]. All sensitivity analyses confirmed the robustness of our findings.

Conclusions

An early approach to invasive mechanical ventilation did not improve outcomes in this matched cohort of patients. The limited number of patients included in these analyses out the total number included in the study may limit generalizability of these findings.

 

 

 

 

Early Neuromuscular Electrical Stimulation in Addition to Early Mobilization Improves Functional Status and Decreases Hospitalization Days of Critically Ill Patients

by Campos, Débora R.; Bueno, Thatiana B. C.; Anjos, Jackeline S. G. G.; Zoppi, Daniel; Dantas, Bruno G.; Gosselink, Rik; Guirro, Rinaldo R. J.; Borges, Marcos C

Critical Care Medicine: April 12, 2022 - Volume - Issue - 10

Objectives: To evaluate the impact of the additional use of early neuromuscular electrical stimulation (NMES) on an early mobilization (EM) protocol.

Design: Randomized controlled trial. Setting: ICU of the Clinical Hospital of Ribeirão Preto, University of São Paulo, Brazil.

Patients: One hundred and thirty-nine consecutive mechanically ventilated patients were included in the first 48 hours of ICU admission. Interventions: The patients were divided into two groups: EM and EM+NMES. Both groups received EM daily. In the EM+NMES group, patients additionally received NMES 5 days a week, for 60 minutes, starting in the first 48 hours of ICU admission until ICU discharge.

Measurements and Main Results: Functional status, muscle strength, ICU and hospital length of stay (LOS), frequency of delirium, days on mechanical ventilation, mortality, and quality of life were assessed. Patients in the EM+NMES group presented a significant higher score of functional status measured by the Functional Status Score for the ICU scale when compared with the EM group in the first day awake: 22 (15–26) versus 12 (8–22) (p = 0.019); at ICU discharge: 28 (21–33) versus 18 (11–26) (p = 0.004); and hospital discharge: 33 (27–35) versus 25 (17–33) (p = 0.014), respectively. They also had better functional status measured by the Physical Function Test in the ICU scale, took less days to stand up during the ICU stay, and had a significant shorter hospital LOS, lower frequency of ICU-acquired weakness, and better global muscle strength.

Conclusions: The additional application of early NMES promoted better functional status outcomes on the first day awake and at ICU and hospital discharge. The patients in the EM+NMES group also took fewer days to stand up and had shorter hospital LOS, lower frequency of ICU-acquired weakness, and better muscle strength. Future studies are still necessary to clarify the effects of therapies associated with EM, especially to assess long-term outcomes.

 

Diarrhea during critical illness: a multicenter cohort study

Intensive Care Medicine volume 48, pages 570–579 (2022) Published: 11 April 2022

Purpose

To study the incidence, predictors, and outcomes of diarrhea during the stay in the intensive care unit (ICU).

Methods

Prospective cohort of consecutive adults in the ICU for > 24 h during a 10-week period across 12 intensive care units (ICUs) internationally. The explored outcomes were: (1) incidence of diarrhea, (2) Clostridioides difficile-associated diarrhea (CDAD); (3) ICU and hospital length of stay (LOS) and mortality in patients with diarrhea. We fit generalized linear models to evaluate the predictors, management, morbidity and mortality associated with diarrhea.

Results

Among 1109 patients aged 61.4 (17.5) [mean (standard deviation)] years, 981(88.5%) were medical and 645 (58.2%) were mechanically ventilated. The incidence was 73.8% (818 patients, 73.8%, 95% confidence interval [CI] 71.1–76.6) using the definition of the World Health Organisation (WHO). Incidence varied across definitions (Bristol 53.5%, 95% CI 50.4–56.7; Bliss 37.7%, 95% CI 34.9–40.4). Of 99 patients with diarrhea undergoing CDAD testing, 23 tested positive (2.2% incidence, 95% CI 1.5–3.4). Independent predictors included enteral nutrition (RR 1.23, 95% CI 1.16–1.31, p < 0.001), antibiotic days (RR 1.02, 95% CI 1.02–1.03, p < 0.001), and suppositories (RR 1.14 95% CI 1.06–1.22, p < 0.001). Opiates decreased diarrhea risk (RR 0.76, 95% CI 0.68–0.86, p < 0.001). Diarrhea prompted management modifications (altered enteral nutrition or medications: RR 10.25, 95% CI 5.14–20.45, p < 0.001) or other consequences (fecal management device or CDAD testing: RR 6.16, 95% CI 3.4–11.17, p < 0.001). Diarrhea was associated with a longer time to discharge for ICU or hospital stay, but was not associated with hospital mortality.

Conclusion

Diarrhea is common, has several predictors, and prompts changes in patient care, is associated with longer time to discharge but not mortality.

Which Models Can I Use to Predict Adult ICU Length of Stay? A Systematic Review

Which Models Can I Use to Predict Adult ICU Length of Stay? A Systematic Review
Verburg, I et al
Critical Care Medicine: February 2017 - Volume 45 - Issue 2 - p e222–e231

Objective: We systematically reviewed models to predict adult ICU length of stay. Data Sources: We searched the Ovid EMBASE and MEDLINE databases for studies on the development or validation of ICU length of stay prediction models. Study Selection: We identified 11 studies describing the development of 31 prediction models and three describing external validation of one of these models. Data Extraction: Clinicians use ICU length of stay predictions for planning ICU capacity, identifying unexpectedly long ICU length of stay, and benchmarking ICUs. We required the model variables to have been published and for the models to be free of organizational characteristics and to produce accurate predictions, as assessed by R2 across patients for planning and identifying unexpectedly long ICU length of stay and across ICUs for benchmarking, with low calibration bias. We assessed the reporting quality using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies. Data Synthesis: The number of admissions ranged from 253 to 178,503. Median ICU length of stay was between 2 and 6.9 days. Two studies had not published model variables and three included organizational characteristics. None of the models produced predictions with low bias. The R2 was 0.05–0.28 across patients and 0.01–0.64 across ICUs. The reporting scores ranged from 49 of 78 to 60 of 78 and the methodologic scores from 12 of 22 to 16 of 22. Conclusion: No models completely satisfy our requirements for planning, identifying unexpectedly long ICU length of stay, or for benchmarking purposes. Physicians using these models to predict ICU length of stay should interpret them with reservation.

Relationship between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors

Relationship between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors

Critical Care Medicine: April 2016 - Volume 44 - Issue 4 - p 655–662

Moitra, V et al

Objectives: To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States. Design: Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1- and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation. Interventions: None. Patients: The cohort included 34,696 Medicare beneficiaries older than 65 years who received intensive care and survived to hospital discharge in 2005. Measurements and Main Results: Among 34,696 patients who survived to hospital discharge, the mean ICU length of stay was 3.4 days (± 4.5 d). Patients (88.9%) were in the ICU for 1–6 days, representing 58.6% of ICU bed-days. Patients (1.3%) were in the ICU for 21 or more days, but these patients used 11.6% of bed-days. The percentage of mechanically ventilated patients increased with increasing length of stay (6.3% for 1–6 d in the ICU and 71.3% for ≥ 21 d). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for 1 day, up to 57.8% for patients in the ICU for 21 or more days. For each day beyond 7 days in the ICU, there was an increased odds of death by 1 year of 1.04 (95% CI, 1.03–1.05) irrespective of the need for mechanical ventilation. Conclusions: Increasing ICU length of stay is associated with higher 1-year mortality for both mechanically ventilated and non–mechanically ventilated patients. No specific cut off was associated with a clear plateau or sharp increase in long-term risk.

Delayed Rapid Response Team Activation Is Associated With Increased Hospital Mortality, Morbidity, and Length of Stay in a Tertiary Care Institution

Delayed Rapid Response Team Activation Is Associated With Increased Hospital Mortality, Morbidity, and Length of Stay in a Tertiary Care Institution

Critical Care Medicine: January 2016 - Volume 44 - Issue 1 - p 54–63
Barwise, A, Thongprayoon, C et al


Objective: To identify whether delays in rapid response team activation contributed to worse patient outcomes (mortality and morbidity). Design: Retrospective observational cohort study including all rapid response team activations in 2012. Setting: Tertiary academic medical center. Patients: All those 18 years old or older who had a rapid response team call activated. Vital sign data were abstracted from individual patient electronic medical records for the 24 hours before the rapid response team activation took place. Patients were considered to have a delayed rapid response team activation if more than 1 hour passed between the first appearance in the record of an abnormal vital sign meeting rapid response team criteria and the activation of an rapid response team. Interventions: None. Measurements and Main Results: A total of 1,725 patients were included in the analysis. Data were compared between those who had a delayed rapid response team activation and those who did not. Fifty seven percent patients met the definition of delayed rapid response team activation. Patients in high-frequency physiologic monitored environments were more likely to experience delay than their floor counterparts. In the no-delay group, the most common reasons for rapid response team activation were tachycardia/bradycardia at 29% (217/748), respiratory distress/low SpO2 at 28% (213/748), and altered level of consciousness at 23% (170/748) compared with respiratory distress/low SpO2 at 43% (423/977), tachycardia/bradycardia at 33% (327/977), and hypotension at 27% (261/977) in the delayed group. The group with no delay had a higher proportion of rapid response team calls between 8:00 and 16:00, whereas those with delay had a higher proportion of calls between midnight and 08:00. The delayed group had higher hospital mortality (15% vs 8%; adjusted odds ratio, 1.6; p = 0.005); 30-day mortality (20% vs 13%; adjusted odds ratio, 1.4; p = 0.02); and hospital length of stay (7 vs 6 d; relative prolongation, 1.10; p = 0.02) compared with the no-delay group. Conclusions: Delays in rapid response team activation occur frequently and are independently associated with worse patient mortality and morbidity outcomes.