Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011) / Características y evolución de los pacientes ingresados en UCI españolas: un estudio observacional prospectivo del registro ENVIN-HELICS (2006-2011)

OBJECTIVE: To describe the case-mix of patients admitted to intensive care units (ICUs) in Spain during the period 2006-2011 and to assess changes in ICU mortality according to severity level. DESIGN: Secondary analysis of data obtained from the ENVN-HELICS registry. Observational prospective study. SETTING: Spanish ICU. Patients: Patients admitted for over 24h. Interventions: None. VARIABLES: Data for each of the participating hospitals and ICUs were recorded, as well as data that allowed to knowing the case-mix and the individual outcome of each patient. The study period was divided into two intervals, from 2006 to 2008 (period 1) and from 2009 to 2011 (period 2). Multilevel and multivariate models were used for the analysis of mortality and were performed in each stratum of severity level. RESULTS: The study population included 142,859 patients admitted to 188 adult ICUs. There was an increase in the mean age of the patients and in the percentage of patients > 79 years (11.2%vs. 12.7%, P < 0.001). Also, the mean APACHE II score increased from 14.35 ± 8.29 to 14.72 ± 8.43 (P < 0.001). The crude overall intra-UCI mortality remained unchanged (11.4%) but adjusted mortality rate in patients with APACHE II score between 11 and 25 decreased modestly in recent years (12.3% vs. 11.6%, odds ratio = 0.931, 95% CI 0.883-0.982; P = 0.008). Conclusion: This study provides observational longitudinal data on case-mix of patients admitted to Spanish ICUs. A slight reduction in ICU mortality rate was observed among patients with intermediate severity level

OBJETIVO: Describir el case-mix de los pacientes admitidos en las unidades de cuidados intensivos (UCI) españolas durante el periodo 2006-2011 y evaluar los cambios en la mortalidad en UCI según el nivel de gravedad. DISEÑO: Estudio prospectivo y observacional. Análisis secundario procedente del registro ENVIN-HELICS. ÁMBITO: ICU españolas. PACIENTES: Pacientes ingresados más de 24h. Intervención: Ninguna. Variables: Se registraron los datos de cada UCI participante, así como aquellos que permiten conocer el case-mix y el estado al alta de cada paciente. El periodo de estudio se dividió en 2 intervalos, de 2006 a 2008 (periodo 1) y de 2009 a 2011 (periodo 2). Para el análisis de la mortalidad y en cada estrato de nivel de gravedad se realizó un estudio multivariante y multinivel. Resultados: La población estudiada incluye 142.859 pacientes ingresados en 188 UCI de adultos. Se apreció un incremento en la media de edad de los pacientes, así como en el porcentaje de los que eran mayores de 79 años (11,2 vs. 12,7%; p < 0,001). La media de APACHE II se incrementó de 14,35 ± 8,29 a 14,72 ± 8,43 (p < 0,001). La mortalidad bruta no varió (11,4%), pero la mortalidad ajustada en pacientes con APACHE II entre 11 y 25 disminuyó modestamente en los últimos años (12,3 vs. 11,6%, odds ratio = 0,931, IC 95% 0,883-0,982; p = 0,008). CONCLUSIONES: Este estudio proporciona datos observacionales del case-mix de los pacientes ingresados en las UCI de España. Se observa una ligera reducción de la mortalidad en los pacientes con un grado intermedio en la escala de gravedad

Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011).

OBJECTIVE: To describe the case-mix of patients admitted to intensive care units (ICUs) in Spain during the period 2006-2011 and to assess changes in ICU mortality according to severity level. DESIGN: Secondary analysis of data obtained from the ENVN-HELICS registry. Observational prospective study. SETTING: Spanish ICU. PATIENTS: Patients admitted for over 24h. INTERVENTIONS: None. VARIABLES: Data for each of the participating hospitals and ICUs were recorded, as well as data that allowed to knowing the case-mix and the individual outcome of each patient. The study period was divided into two intervals, from 2006 to 2008 (period 1) and from 2009 to 2011 (period 2). Multilevel and multivariate models were used for the analysis of mortality and were performed in each stratum of severity level. RESULTS: The study population included 142,859 patients admitted to 188 adult ICUs. There was an increase in the mean age of the patients and in the percentage of patients >79 years (11.2% vs. 12.7%, P<0.001). Also, the mean APACHE II score increased from 14.35±8.29 to 14.72±8.43 (P<0.001). The crude overall intra-UCI mortality remained unchanged (11.4%) but adjusted mortality rate in patients with APACHE II score between 11 and 25 decreased modestly in recent years (12.3% vs. 11.6%, odds ratio=0.931, 95% CI 0.883-0.982; P=0.008). CONCLUSION: This study provides observational longitudinal data on case-mix of patients admitted to Spanish ICUs. A slight reduction in ICU mortality rate was observed among patients with intermediate severity level.

Análisis comparativo de pacientes ingresados en Unidades de Cuidados Intensivos españolas por causa médica y quirúrgica / Comparative analysis of patients admitted to Spanish Intensive Care Units due to medical and surgical disease

OBJETIVO: Describir el case-mix de los pacientes médicos y quirúrgicos ingresados en UCI y comparar ambas poblaciones. DISEÑO: Análisis de datos de pacientes ingresados en UCI entre 2006 y 2011, extraídos del registro ENVIN-HELICS. Estudio observacional, prospectivo, multicéntrico y de participación voluntaria. Ámbito: Ciento ochenta y ocho Unidades de Cuidados Intensivos españolas. PARTICIPANTES: Pacientes ingresados durante más de 24 h. Variables de interés principales: Datos demográficos, causa de ingreso, escalas de gravedad, tiempo de estancia y mortalidad. RESULTADOS: Se analiza a 138.999 pacientes. El motivo de ingreso era médico no coronario en 65.467 (47,1%), coronario en 27.785 (20,0%), postoperatorio de cirugía programada en 28.044 (20,2%) y urgente en 17.613 (12,7%). Los pacientes quirúrgicos urgentes precisan mayor utilización de dispositivos y presentan más infecciones nosocomiales y por patógenos multirresistentes. La mediana de estancia en UCI es más prolongada en estos pacientes (5 días; rango intercuartílico: 2-11), así como la media de APACHE II y SAPS II. La mortalidad global es superior en pacientes médicos no coronarios (16,6%). Categorizando a los pacientes según el valor APACHE II, la mortalidad es mayor para todos los niveles en los pacientes quirúrgicos urgentes que en los programados, dándose la mayor diferencia en aquellos con APACHE II entre 6 y 10: el 3 y el 0,9%, respectivamente; OR: 2,141 (IC del 95%, 1,825-2,513); p < 0,001. CONCLUSIONES: Los pacientes médicos no coronarios presentan mayor mortalidad, pero son los quirúrgicos urgentes los que precisan mayor uso de recursos por paciente. La escala APACHE II infraestima la mortalidad en pacientes quirúrgicos urgentes

OBJECTIVE: To describe the characteristics of the patients case-mix admitted to ICUs due to medical and surgical disease, and to compare both groups. DESIGN: Analysis of data covering the period 2006-2011 in the ENVIN-HELICS registry. An observational, prospective, multicenter and voluntary participation study. Setting: A total of 188 Spanish ICUs. Patients: All patients admitted for more than 24 hours. MAIN VARIABLES: Demographic data, cause of admission, severity scores, length of stay, mortality. RESULTS: A total of 138,999 patients were analyzed. Of these, 65,467 (47.1%) were admitted due to a non-coronary medical cause, 27,785 (20,0%) due to coronary-related illness, 28,044 (20,2%) after elective surgery and 17,613 (12.7%) after urgent surgery. Use of devices, nosocomial infections and isolation of multirresistant organisms were more prevalent in urgent surgery patients. Longer length of stay (median 5 days; interquartile range 2-11) as well as higher severity scale values (APACHE II and SAPS II) corresponded to this same group of patients. Mortality was higher in non-coronay medical patients. On categorizing the patients according to the APACHE II score, mortality was seen to be higher in urgent surgery cases than in elective surgery patients in all groups. The largest difference was observed in the APACHE II score 6-10 group (3% vs. 0.9%) (OR: 2.14, 95% CI 1.825-2.513; p<0.001). CONCLUSIONS: The mortality rate is higher in non-coronary medical patients, though resource use per patient is greater in the urgent surgery cases. The APACHE II scale underestimates mortality in emergency surgery patients

[Comparative analysis of patients admitted to Spanish Intensive Care Units due to medical and surgical disease]. / Análisis comparativo de pacientes ingresados en Unidades de Cuidados Intensivos españolas por causa médica y quirúrgica.

OBJECTIVE: To describe the characteristics of the patients case-mix admitted to ICUs due to medical and surgical disease, and to compare both groups. DESIGN: Analysis of data covering the period 2006-2011 in the ENVIN-HELICS registry. An observational, prospective, multicenter and voluntary participation study. SETTING: A total of 188 Spanish ICUs. PATIENTS: All patients admitted for more than 24 hours. MAIN VARIABLES: Demographic data, cause of admission, severity scores, length of stay, mortality. RESULTS: A total of 138,999 patients were analyzed. Of these, 65,467 (47.1%) were admitted due to a non-coronary medical cause, 27,785 (20,0%) due to coronary-related illness, 28,044 (20,2%) after elective surgery and 17,613 (12.7%) after urgent surgery. Use of devices, nosocomial infections and isolation of multirresistant organisms were more prevalent in urgent surgery patients. Longer length of stay (median 5 days; interquartile range 2-11) as well as higher severity scale values (APACHE II and SAPS II) corresponded to this same group of patients. Mortality was higher in non-coronay medical patients. On categorizing the patients according to the APACHE II score, mortality was seen to be higher in urgent surgery cases than in elective surgery patients in all groups. The largest difference was observed in the APACHE II score 6-10 group (3% vs. 0.9%) (OR: 2.14, 95% CI 1.825-2.513; p<0.001). CONCLUSIONS: The mortality rate is higher in non-coronary medical patients, though resource use per patient is greater in the urgent surgery cases. The APACHE II scale underestimates mortality in emergency surgery patients.

Urethral catheter-related urinary infection in critical patients admitted to the ICU. Descriptive data of the ENVIN-UCI study.

OBJECTIVE: To describe trends in national catheter-related urinary tract infection (CRUTI) rates, as well as etiologies and multiresistance markers. DESIGN: An observational, prospective, multicenter voluntary participation study was conducted from 1 April to 30 June in the period between 2005 and 2010. SETTING: Intensive Care Units (ICUs) that participated in the ENVIN-ICU registry during the study period. PATIENTS: We included all patients admitted to the participating ICUs and patients with urinary catheter placement for more than 24 hours (78,863 patients). INTERVENTION: Patient monitoring was continued until discharge from the ICU or up to 60 days. VARIABLES OF INTEREST: CRUTIs were defined according to the CDC system, and frequency is expressed as incidence density (ID) in relation to the number of urinary catheter-patients days. RESULTS: A total of 2329 patients (2.95%) developed one or more CRUTI. The ID decreased from 6.69 to 4.18 episodes per 1000 days of urinary catheter between 2005 and 2010 (p<0.001). In relation to the underlying etiology, gramnegative bacilli predominated (55.6 to 61.6%), followed by fungi (18.7 to 25.2%) and grampositive cocci (17.1 to 25.9%). In 2010, ciprofloxacin-resistant E. coli strains (37.1%) increased, as well as imipenem-resistant (36.4%) and ciprofloxacin-resistant (37.1%) strains of P. aeruginosa. CONCLUSIONS: A decrease was observed in CRUTI rates, maintaining the same etiological distribution and showing increased resistances in gramnegative pathogens, especially E. coli and P. aeruginosa.