Prognostic Impact of In-Hospital Emergency in Patients Admitted for Non-Surgical Intensive Care.

BACKGROUND

We aimed to elucidate the prognostic impact of in-hospital emergencies among patients who require non-surgical intensive care.

METHODS AND

RESULTS

In total, 4,483 patients requiring non-surgical intensive care from 2011 to 2021 were included. Patient backgrounds, in-hospital management, and prognoses were compared among 4 groups according to the hospitalization route: walk-ins (group A; n=636); ambulance (group B; n=2,748); helicopter/car-based emergency medical service (group C; n=565); and in-hospital emergencies (group D; n=534). The proportion of patients admitted to the intensive care unit after in-hospital emergencies was 38.0% among those with sepsis and 29.7% among those with other non-cardiovascular diseases. Furthermore, acute heart failure (AHF), sepsis and other non-cardiovascular disease were the most common diseases in patients with in-hospital emergencies (24.3%, 23.2% and 21.5%, respectively). Kaplan-Meier curve analysis revealed that the prognosis (365-day all-cause mortality) was significantly poorer in group D than in the other groups. A multivariable Cox regression model identified group D as an independent predictor of 365-day all-cause mortality (hazard ratio 1.227; 95% confidence interval 1.027-1.467) relative to out-of-hospital admissions, especially in AHF and non-cardiovascular disease.

CONCLUSIONS

Patients who required non-surgical intensive care after in-hospital emergencies mainly have AHF and non-cardiovascular etiologies such as sepsis. In-hospital emergency was identified as a significant factor associated with a higher 365-day mortality rate. A clinical approach to reduce their mortality is urgently needed.