Death in hospital following ICU discharge: insights from the LUNG SAFE study
Authors: Madotto Fabiana , McNicholas Bairbre , Rezoagli Emanuele , Pham Tài , Laffey John G. , Bellani Giacomo ,   the LUNG SAFE Investigators, Pesenti Antonio , Laffey John G. , Brochard Laurent , Esteban Andres , Gattinoni Luciano , van Haren Frank , Ranieri Marco , Rubenfeld Gordon , Rubenfeld Gordon , Thompson B. Taylor , Slutsky Arthur S. , Rios Fernando , van Haren Frank , Faruq Mohammad Omar , Sottiaux T. , Depuydt P. , Lora Fredy S. , Azevedo Cesar Cesar , Fan Eddy , Bugedo Guillermo , Qiu Haibo , Gonzalez Marcos , Silesky Juan , Cerny Vladimir , Nielsen Jonas , Jibaja Manuel , Pham Tài , Wrigge Hermann , Matamis Dimitrios , Ranero Jorge Luis , Gomersall Charles , Amin Pravin , Hashemian S. M. , Clarkson Kevin , Bellani Giacomo , Kurahashi Kiyoyasu , Koh Younsuck , Villagomez Asisclo , Zeggwagh Amine Ali , Heunks Leo M. , Laake Jon Henrik , Kashif Waqar , Synclair Jorge , Palo Jose Emmanuel , do Vale Fernandes Antero , Sandesc Dorel , Arabi Yaasen , Bumbasierevic Vesna , Nin Nicolas , Lorente Jose A. , Larsson Anders , Piquilloud Lise , Patjanasoontorn Boonsong , Abroug Fekri , McAuley Daniel F. , McNamee Lia , Hurtado Javier , Bajwa Ed , Démpaire Gabriel , Francois Guy M. , Rabboni Francesca , Madotto Fabiana , Conti Sara , Sula Hektor , Nunci Lordian , Cani Alma , Zazu Alan , Dellera Christian , Insaurralde Carolina S. , Alejandro Risso V. , Daldin Julio , Vinzio Mauricio , Fernandez Ruben O. , Cardonnet Luis P. , Bettini Lisandro R. , Bisso Mariano Carboni , Osman Emilio M. , Setten Mariano G. , Lovazzano Pablo , Alvarez Javier , Villar Veronica , Pozo Norberto C. , Grubissich Nicolas , Plotnikow Gustavo A. , Vasquez Daniela N. , Ilutovich Santiago , Tiribelli Norberto , Chena Ariel , Pellegrini Carlos A. , Saenz María G. , Estenssoro Elisa , Brizuela Matias , Gianinetto Hernan , Gomez Pablo E. , Cerrato Valeria I. , Bezzi Marco G. , Borello Silvina A. , Loiacono Flavia A. , Fernandez Adriana M. , Knowles Serena , Reynolds Claire , Inskip Deborah M. , Miller Jennene J. , Kong Jing , Whitehead Christina , Bihari Shailesh , Seven Aylin , Krstevski Amanda , Rodgers Helen J. , Millar Rebecca T. , Mckenna Toni E. , Bailey Irene M. , Hanlon Gabrielle C. , Aneman Anders , Lynch Joan M. , Azad Raman , Neal John , Woods Paul W. , Roberts Brigit L. , Kol Mark R. , Wong Helen S. , Riss Katharina C. , Staudinger Thomas , Wittebole Xavier , Berghe Caroline , Bulpa Pierre A. , Dive Alain M. , Verstraete Rik , Lebbinck Herve , Depuydt Pieter , Vermassen Joris , Meersseman Philippe , Ceunen Helga , Rosa Jonas I. , Beraldo Daniel O. , Piras Claudio , Rampinelli Adenilton M. , Nassar ñ P. , Mataloun Sergio , Moock Marcelo , Thompson Marlus M. , Gonçalves Claudio H. , Antônio Ana Carolina P. , Ascoli Aline , Biondi Rodrigo S. , Fontenele Danielle C. , Nobrega Danielle , Sales Vanessa M. , Shindhe Suresh , Aiman Dk Maizatul , Ismail BPg Hj , Laffey John , Beloncle Francois , Davies Kyle G. , Cirone Rob , Manoharan Venika , Ismail Mehvish , Goligher Ewan C. , Jassal Mandeep , Ferguson Niall D. , Nishikawa Erin , Javeed Areej , Curley Gerard , Rittayamai Nuttapol , Parotto Matteo , Mehta Sangeeta , Knoll Jenny , Pronovost Antoine , Canestrini Sergio , Bruhn Alejandro R. , Garcia Patricio H. , Aliaga Felipe A. , Farías Pamela A. , Yumha Jacob S. , Ortiz Claudia A. , Salas Javier E. , Saez Alejandro A. , Vega Luis D. , Labarca Eduardo F. , Martinez Felipe T. , Carreño Nicolás G. , Lora Pilar , Liu Haitao , Qiu Haibo , Liu Ling , Tang Rui , Luo Xiaoming , An Youzhong , Zhao Huiying , Gao Yan , Zhai Zhe , Ye Zheng L. , Wang Wei , Li Wenwen , Li Qingdong , Zheng Ruiqiang , Yu Wenkui , Shen Juanhong , Li Xinyu , Yu Tao , Lu Weihua , Wu Ya Q. , Huang Xiao B. , He Zhenyang , Lu Yuanhua , Han Hui , Zhang Fan , Sun Renhua , Wang Hua X. , Qin Shu H. , Zhu Bao H. , Zhao Jun , Liu Jian , Li Bin , Liu Jing L. , Zhou Fa C. , Li Qiong J. , Zhang Xing Y. , Li-Xin Zhou , Xin-Hua Qiang , Jiang Liangyan , Gao Yuan N. , Zhao Xian Y. , Li Yuan Y. , Li Xiao L. , Wang Chunting , Yao Qingchun , Yu Rongguo , Chen Kai , Shao Huanzhang , Qin Bingyu , Huang Qing Q. , Zhu Wei H. , Hang Ai Y. , Hua Ma X. , Li Yimin , Xu Yonghao , Di Yu D. , Ling Long L. , Qin Tie H. , Wang Shou H. , Qin Junping , Han Yi , Zhou Suming , Vargas Monica P. , Jimenez Juan I. Silesky , Rojas Manuel A. González , Solis-Quesada Jaime E. , Ramirez-Alfaro Christian M. , Máca Jan , Sklienka Peter , Gjedsted Jakob , Christiansen Aage , Nielsen Jonas , Villamagua Boris G. , Llano Miguel , Burtin Philippe , Buzancais Gautier , Beuret Pascal , Pelletier Nicolas , Mortaza Satar , Mercat Alain , Chelly Jonathan , Jochmans Sébastien , Terzi Nicolas , Daubin Cédric , Carteaux Guillaume , de Prost Nicolas , Chiche Jean-Daniel , Daviaud Fabrice , Pham Tài , Fartoukh Muriel , Barberet Guillaume , Biehler Jerome , Dellamonica Jean , Doyen Denis , Arnal Jean-Michel , Briquet Anais , Klasen Fanny , Papazian Laurent , Follin Arnaud , Roux Damien , Messika Jonathan , Kalaitzis Evangelos , Dangers Laurence , Combes Alain , Au Siu-Ming , Béduneau Gaetan , Carpentier Dorothée , Zogheib Elie H. , Dupont Herve , Ricome Sylvie , Santoli Francesco L. , Besset Sebastien L. , Michel Philippe , Gelée Bruno , Danin Pierre-Eric , Goubaux Bernard , Crova Philippe J. , Phan Nga T. , Berkelmans Frantz , Badie Julio C. , Tapponnier Romain , Gally Josette , Khebbeb Samy , Herbrecht Jean-Etienne , Schneider Francis , Declercq Pierre-Louis M. , Rigaud Jean-Philippe , Duranteau Jacques , Harrois Anatole , Chabanne Russell , Marin Julien , Constantin Jean-Michel , Thibault Sandrine , Ghazi Mohammed , Boukhazna Messabi , Zein Salem Ould , Richecoeur Jack R. , Combaux Daniele M. , Grelon Fabien , Le Moal Charlene , Sauvadet Elise P. , Robine Adrien , Lemiale Virginie , Reuter Danielle , Dres Martin , Demoule Alexandre , Goldgran-Toledano Dany , Baboi Loredana , Guérin Claude , Lohner Ralph , Kraßler Jens , Schäfer Susanne , Zacharowski Kai D. , Meybohm Patrick , Reske Andreas W. , Simon Philipp , Hopf Hans-Bernd F. , Schuetz Michael , Baltus Thomas , Papanikolaou Metaxia N. , Papavasilopoulou Theonymfi G. , Zacharas Giannis A. , Ourailogloy Vasilis , Mouloudi Eleni K. , Massa Eleni V. , Nagy Eva O. , Stamou Electra E. , Kiourtzieva Ellada V. , Oikonomou Marina A. , Avila Luis E. , Cortez Cesar A. , Citalán Johanna E. , Jog Sameer A. , Sable Safal D. , Shah Bhagyesh , Gurjar Mohan , Baronia Arvind K. , Memon Mohammedfaruk , Muthuchellappan Radhakrishnan , Ramesh Venkatapura J. , Shenoy Anitha , Unnikrishnan Ramesh , Dixit Subhal B. , Rhayakar Rachana V. , Ramakrishnan Nagarajan , Bhardwaj Vallish K. , Mahto Heera L. , Sagar Sudha V. , Palaniswamy Vijayanand , Ganesan Deeban , Hashemian Seyed Mohammadreza , Jamaati Hamidreza , Heidari Farshad , Meaney Edel A. , Nichol Alistair , Knapman Karl M. , O’Croinin Donall , Dunne Eimhin S. , Breen Dorothy M. , Clarkson Kevin P. , Jaafar Rola F. , Dwyer Rory , Amir Fahd , Ajetunmobi Olaitan O. , O’Muircheartaigh Aogan C. , Black Colin S. , Treanor Nuala , Collins Daniel V. , Altaf Wahid , Zani Gianluca , Fusari Maurizio , Spadaro Savino , Volta Carlo A. , Graziani Romano , Brunettini Barbara , Palmese Salvatore , Formenti Paolo , Umbrello Michele , Lombardo Andrea , Pecci Elisabetta , Botteri Marco , Savioli Monica , Protti Alessandro , Mattei Alessia , Schiavoni Lorenzo , Tinnirello Andrea , Todeschini Manuel , Giaccone Policlinico P. , Giarratano Antonino , Cortegiani Andrea , Sher Sara , Rossi Anna , Antonelli Massimo M. , Montini Luca M. , Casalena Paolo , Scafetti Sergio , Panarello Giovanna , Occhipinti Giovanna , Patroniti Nicolò , Pozzi Matteo , Biscione Roberto R. , Poli Michela M. , Raimondi Ferdinando , Albiero Daniela , Crapelli Giulia , Beck Eduardo , Pota Vincenzo , Schiavone Vincenzo , Molin Alexandre , Tarantino Fabio , Monti Giacomo , Frati Elena , Mirabella Lucia , Cinnella Gilda , Fossali Tommaso , Colombo Riccardo , Pattarino Pierpaolo Terragni Ilaria , Mojoli Francesco , Braschi Antonio , Borotto Erika E. , Cracchiolo Andrea N. , Palma Daniela M. , Raponi Francesco , Foti Giuseppe , Vascotto Ettore R. , Coppadoro Andrea , Brazzi Luca , Floris Leda , Iotti Giorgio A. , Venti Aaron , Yamaguchi Osamu , Takagi Shunsuke , Maeyama Hiroki N. , Watanabe Eizo , Yamaji Yoshihiro , Shimizu Kazuyoshi , Shiozaki Kyoko , Futami Satoru , Ryosuke Sekine , Saito Koji , Kameyama Yoshinobu , Ueno Keiko , Izawa Masayo , Okuda Nao , Suzuki Hiroyuki , Harasawa Tomofumi , Nasu Michitaka , Takada Tadaaki , Ito Fumihito , Nunomiya Shin , Koyama Kansuke , Abe Toshikazu , Andoh Kohkichi , Kusumoto Kohei , Hirata Akira , Takaba Akihiro , Kimura Hiroyasu , Matsumoto Shuhei , Higashijima Ushio , Honda Hiroyuki , Aoki Nobumasa , Imai Hiroshi , Ogino Yasuaki , Mizuguchi Ichiko , Ichikado Kazuya , Nitta Kenichi , Mochizuki Katsunori , Hashida Tomoaki , Tanaka Hiroyuki , Nakamura Tomoyuki , Niimi Daisuke , Ueda Takeshi , Kashiwa Yozo , Uchiyama Akinori , Sabelnikovs Olegs , Oss Peteris , Haddad Youssef , Liew Kong Y. , Ñamendys-Silva Silvio A. , Jarquin-Badiola Yves D. , Sanchez-Hurtado Luis A. , Gomez-Flores Saira S. , Marin Maria C. , Villagomez Asisclo J. , Lemus Jordana S. , Fierro Jonathan M. , Cervantes Mavy Ramirez , Mejia Francisco Javier Flores , Dector Dulce , Dector Dulce M. , Gonzalez Daniel R. , Estrella Claudia R. , Sanchez-Medina Jorge R. , Ramirez-Gutierrez Alvaro , George Fernando G. , Aguirre Janet S. , Buensuseso Juan A. , Poblano Manuel , University Mohammed V. , Dendane Tarek , Zeggwagh Amine Ali , Balkhi Hicham , Elkhayari Mina , Samkaoui Nacer , Ezzouine Hanane , Benslama Abdellatif , Amor Mourad , Maazouzi Wajdi , Cimic Nedim , Beck Oliver , Bruns Monique M. , Schouten Jeroen A. , Rinia Myra , Raaijmakers Monique , Heunks Leo M. , Van Wezel Hellen M. , Heines Serge J. , Strauch Ulrich , Buise Marc P. , Simonis Fabienne D. , Schultz Marcus J. , Goodson Jennifer C. , Browne Troy S. , Navarra Leanlove , Hunt Anna , Hutchison Robyn A. , Bailey Mathew B. , Newby Lynette , Mcarthur Colin , Kalkoff Michael , Mcleod Alex , Casement Jonathan , Hacking Danielle J. , Andersen Finn H. , Dolva Merete S. , Laake Jon H. , Barratt-Due Andreas , Noremark Kim Andre L. , Søreide Eldar , Sjøbø Brit Å. , Guttormsen Anne B. , Yoshido Hector H. Leon , Aguilar Ronald Zumaran , Oscanoa Fredy A. Montes , Alisasis Alain U. , Robles Joanne B. , Pasanting-Lim Rossini Abbie B. , Tan Beatriz C. , Andruszkiewicz Pawel , Jakubowska Karina , Coxo Cristina M. , Alvarez António M. , Oliveira Bruno S. , Montanha Gustavo M. , Barros Nelson C. , Pereira Carlos S. , Messias António M. , Monteiro Jorge M. , Araujo Ana M. , Catorze Nuno T. , Marum Susan M. , Bouw Maria J. , Gomes Rui M. , Brito Vania A. , Castro Silvia , Estilita Joana M. , Barros Filipa M. , Serra Isabel M. , Martinho Aurelia M. , Tomescu Dana R. , Marcu Alexandra , Bedreag Ovidiu H. , Papurica Marius , Corneci Dan E. , Negoita Silvius Ioan , Grigoriev Evgeny , Gritsan Alexey I. , Gazenkampf Andrey A. , Almekhlafi Ghaleb , Albarrak Mohamad M. , Mustafa Ghanem M. , Maghrabi Khalid A. , Salahuddin Nawal , Aisa Tharwat M. , Al Jabbary Ahmed S. , Tabhan Edgardo , Arabi Yaseen M. , Trinidad Olivia A. , Al Dorzi Hasan M. , Tabhan Edgardo E. , Bolon Stefan , Smith Oliver , Mancebo Jordi , Aguirre-Bermeo Hernan , Lopez-Delgado Juan C. , Esteve Francisco , Rialp Gemma , Forteza Catalina , De Haro Candelaria , Artigas Antonio , Albaiceta Guillermo M. , De Cima-Iglesias Sara , Seoane-Quiroga Leticia , Ceniceros-Barros Alexandra , Ruiz-Aguilar Antonio L. , Claraco-Vega Luis M. , Soler Juan Alfonso , del Carmen Lorente Maria , Hermosa Cecilia , Gordo Federico , Prieto-González Miryam , López-Messa Juan B. , Perez Manuel P. , Perez Cesar P. , Allue Raquel Montoiro , Roche-Campo Ferran , Ibañez-Santacruz Marcos , Temprano Susana , Pintado Maria C. , De Pablo Raul , Gómez Pilar Ricart Aroa , Ruiz Silvia Rodriguez , Moles Silvia Iglesias , Jurado Mª Teresa , Arizmendi Alfons , Piacentini Enrique A. , Franco Nieves , Honrubia Teresa , Cheng Meisy Perez , Losada Elena Perez , Blanco Javier , Yuste Luis J. , Carbayo-Gorriz Cecilia , Cazorla-Barranquero Francisca G. , Alonso Javier G. , Alda Rosa S. , Algaba Ángela , Navarro Gonzalo , Cereijo Enrique , Diaz-Rodriguez Esther , Marcos Diego Pastor , Montero Laura Alvarez , Para Luis Herrera , Sanchez Roberto Jimenez , Navalpotro Miguel Angel Blasco , Abad Ricardo Diaz , lez Raquel Montiel Gonz á , Toribio Dácil Parrilla , Castro Alejandro G. , Artiga Maria Jose D. , Penuelas Oscar , Roser Tomas P. , Olga Moreno F. , Curto Elena Gallego , Sánchez Rocío Manzano , Imma Vallverdu P. , Elisabet Garcia M. , Claverias Laura , Magret Monica , Pellicer Ana M. , Rodriguez Lucia L. , Sánchez-Ballesteros Jesús , González-Salamanca Ángela , Jimenez Antonio G. , Huerta Francisco P. , Diaz Juan Carlos J. Sotillo , Lopez Esther Bermejo , Moya David D. Llinares , Alfonso Alec A. Tallet , Luis Palazon Sanchez Eugenio , Cesar Palazon Sanchez , Rafael Sánchez I. , Virgilio Corcoles G. , Recio Noelia N. , Adamsson Richard O. , Rylander Christian C. , Holzgraefe Bernhard , Broman Lars M. , Wessbergh Joanna , Persson Linnea , Schiöler Fredrik , Kedelv Hans , Tibblin Anna Oscarsson , Appelberg Henrik , Hedlund Lars , Helleberg Johan , Eriksson Karin E. , Glietsch Rita , Larsson Niklas , Nygren Ingela , Nunes Silvia L. , Morin Anna-Karin , Kander Thomas , Adolfsson Anne , Piquilloud Lise , Zender Hervé O. , Leemann-Refondini Corinne , Elatrous Souheil , Bouchoucha Slaheddine , Chouchene Imed , Ouanes Islem , Marsa La , Souissi Asma Ben , Kamoun Salma , Demirkiran Oktay , Aker Mustafa , Erbabacan Emre , Ceylan Ilkay , Girgin Nermin Kelebek , Ozcelik Menekse , Ünal Necmettin , Meco Basak Ceyda , Akyol Onat O. , Derman Suleyman S. , Kennedy Barry , Parhar Ken , Srinivasa Latha , McNamee Lia , McAuley Danny , Hopkins Phil , Mellis Clare , Kakar Vivek , Hadfield Dan , Vercueil Andre , Bhowmick Kaushik , Humphreys Sally K. , Ferguson Andrew , Mckee Raymond , Raj Ashok S. , Fawkes Danielle A. , Watt Philip , Twohey Linda , Thomas Rajeev R. JhaMatthew , Morton Alex , Kadaba Varsha , Smith Mark J. , Hormis Anil P. , Kannan Santhana G. , Namih Miriam , Reschreiter Henrik , Camsooksai Julie , Kumar Alek , Rugonfalvi Szabolcs , Nutt Christopher , Oneill Orla , Seasman Colette , Dempsey Ged , Scott Christopher J. , Ellis Helen E. , Mckechnie Stuart , Hutton Paula J. , Di Tomasso Nora N. , Vitale Michela N. , Griffin Ruth O. , Dean Michael N. , Cranshaw Julius H. , Willett Emma L. , Ioannou Nicholas , Gillis Sarah , Csabi Peter , Macfadyen Rosaleen , Dawson Heidi , Preez Pieter D. , Williams Alexandra J. , Boyd Owen , De Gordoa Laura Ortiz-Ruiz , Bramall Jon , Symmonds Sophie , Chau Simon K. , Wenham Tim , Szakmany Tamas , Toth-Tarsoly Piroska , Mccalman Katie H. , Alexander Peter , Stephenson Lorraine , Collyer Thomas , Chapman Rhiannon , Cooper Raphael , Allan Russell M. , Sim Malcolm , Wrathall David W. , Irvine Donald A. , Zantua Kim S. , Adams John C. , Burtenshaw Andrew J. , Sellors Gareth P. , Welters Ingeborg D. , Williams Karen E. , Hessell Robert J. , Oldroyd Matthew G. , Battle Ceri E. , Pillai Suresh , Kajtor Istvan , Sivashanmugavel Mageswaran , Okane Sinead C. , Donnelly Adrian , Frigyik Aniko D. , Careless Jon P. , May Martin M. , Stewart Richard , Trinder T. John , Hagan Samantha J. , Wise Matt P. , Cole Jade M. , MacFie Caroline C. , Dowling Anna T. , Hurtado Javier , Nin Nicolás , Hurtado Javier , Nuñez Edgardo , Pittini Gustavo , Rodriguez Ruben , Imperio María C. , Santos Cristina , Deicas Alberto , Serra Carolina , Uppalapati Aditya , Kamel Ghassan , Banner-Goodspeed Valerie M. , Beitler Jeremy R. , Mukkera Satyanarayana Reddy , Kulkarni Shreedhar , Lee Jarone , Mesar Tomaz , Shinn Iii John O. , Gomaa Dina , Tainter Christopher , Lee Jarone , Mesar Tomaz , Lee Jarone , Yeatts Dale J. , Warren Jessica , Lanspa Michael J. , Miller Russel R. , Grissom Colin K. , Brown Samuel M. , Bauer Philippe R. , Gosselin Ryan J. , Kitch Barrett T. , Cohen Jason E. , Beegle Scott H. , Gueret Renaud M. , Tulaimat Aiman , Choudry Shazia , Stigler William , Batra Hitesh , Huff Nidhi G. , Lamb Keith D. , Oetting Trevor W. , Mohr Nicholas M. , Judy Claine , Saito Shigeki , Kheir Fayez M. , Kheir Fayez , Schlichting Adam B. , Delsing Angela , Crouch Daniel R. , Elmasri Mary , Crouch Daniel R. , Ismail Dina , Dreyer Kyle R. , Blakeman Thomas C. , Dreyer Kyle R. , Gomaa Dina , Baron Rebecca M. , Grijalba Carolina Quintana , Hou Peter C. , Seethala Raghu , Aisiku Imo , Henderson Galen , Frendl Gyorgy , Hou Sen-Kuang , Owens Robert L. , Schomer Ashley , Bumbasirevic Vesna , Jovanovic Bojan , Surbatovic Maja , Veljovic Milic ,   the ESICM Trials Group, Laffey John G. , Bellani Giacomo , Pesenti Antonio 
Published: April 2021

Background

To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.

Methods

The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.

Results

2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge.

Conclusions

A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors.

Trial Registration: ClinicalTrials.govNCT02010073.