Do-not-attempt resuscitation independently predict in-hospital mortality in septic patients

Research output: Contribution to journalArticle

Abstract

Introduction: Sepsis patients require timely and appropriate treatment in an intensive care setting. However, “do-not-attempt resuscitation” (DNAR) status may affect physicians' priorities and treatment preferences. The aim of this study was to evaluate whether DNAR status affects the outcomes of septic patients. Methods: This was a retrospective cohort study included septic patients admitted to the emergency department intensive care unit (ED-ICU) in a university-based teaching hospital during April–November 2015. Septic patients admitted to the ED-ICU were included. Results: Of the 132 eligible patients, 49.2% (65/132) had DNAR status (median age 80 years old, IQR, 73–86). The overall in-hospital mortality rate was 28.8% (38/132). Non-survivors had a higher percentage of receiving inotropes/vasopressors (52.6% vs 34.0%, p = 0.048), higher median Charlson comorbidity index scores [8.5 (IQR, 7–11.75) vs 8 (IQR, 6–9), p = 0.012], higher APACHE II score [25 (IQR, 20–30.25) vs 20 (IQR, 17–25), p = 0.002], and higher SOFA score [7 (IQR, 6–11) vs 6 (IQR,4–8), p = 0.012]. There was no significant difference in intubation among the two groups. In a multivariate logistic regression analysis, DNAR status was an independent predictor of in-hospital mortality (odds ratio = 6.22, 95% confidence interval (CI) = (2.71–17.88), p < 0.001). The area under the ROC curve for the logistic regression model was 0.84 [95% CI = (0.77–0.92), p < 0.001]. In subgroup analysis, DNAR status remained an independent predictor of mortality among age ≥65 years and ≥80 years. Conclusion: After adjusting for comorbidities, treatments, and illness severity, DNAR status was associated with in-hospital mortality of septic patients. Further studies should evaluate physicians' attitudes toward septic patients with DNAR status.

Original languageEnglish
Article number158362
JournalAmerican Journal of Emergency Medicine
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Hospital Mortality
Resuscitation
Logistic Models
Intensive Care Units
Hospital Emergency Service
Comorbidity
Confidence Intervals
Physicians
APACHE
Mortality
Critical Care
Intubation
ROC Curve
Teaching Hospitals
Area Under Curve
Sepsis
Cohort Studies
Therapeutics
Retrospective Studies
Odds Ratio

Keywords

  • Do-not-attempt resuscitation
  • Sepsis

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{6e90b4e5525a414e8f8e7276d5b307c3,
title = "Do-not-attempt resuscitation independently predict in-hospital mortality in septic patients",
abstract = "Introduction: Sepsis patients require timely and appropriate treatment in an intensive care setting. However, “do-not-attempt resuscitation” (DNAR) status may affect physicians' priorities and treatment preferences. The aim of this study was to evaluate whether DNAR status affects the outcomes of septic patients. Methods: This was a retrospective cohort study included septic patients admitted to the emergency department intensive care unit (ED-ICU) in a university-based teaching hospital during April–November 2015. Septic patients admitted to the ED-ICU were included. Results: Of the 132 eligible patients, 49.2{\%} (65/132) had DNAR status (median age 80 years old, IQR, 73–86). The overall in-hospital mortality rate was 28.8{\%} (38/132). Non-survivors had a higher percentage of receiving inotropes/vasopressors (52.6{\%} vs 34.0{\%}, p = 0.048), higher median Charlson comorbidity index scores [8.5 (IQR, 7–11.75) vs 8 (IQR, 6–9), p = 0.012], higher APACHE II score [25 (IQR, 20–30.25) vs 20 (IQR, 17–25), p = 0.002], and higher SOFA score [7 (IQR, 6–11) vs 6 (IQR,4–8), p = 0.012]. There was no significant difference in intubation among the two groups. In a multivariate logistic regression analysis, DNAR status was an independent predictor of in-hospital mortality (odds ratio = 6.22, 95{\%} confidence interval (CI) = (2.71–17.88), p < 0.001). The area under the ROC curve for the logistic regression model was 0.84 [95{\%} CI = (0.77–0.92), p < 0.001]. In subgroup analysis, DNAR status remained an independent predictor of mortality among age ≥65 years and ≥80 years. Conclusion: After adjusting for comorbidities, treatments, and illness severity, DNAR status was associated with in-hospital mortality of septic patients. Further studies should evaluate physicians' attitudes toward septic patients with DNAR status.",
keywords = "Do-not-attempt resuscitation, Sepsis",
author = "Wang, {An Yi} and Chang, {Cheng Kuei}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ajem.2019.158362",
language = "English",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders",

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T1 - Do-not-attempt resuscitation independently predict in-hospital mortality in septic patients

AU - Wang, An Yi

AU - Chang, Cheng Kuei

PY - 2019/1/1

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N2 - Introduction: Sepsis patients require timely and appropriate treatment in an intensive care setting. However, “do-not-attempt resuscitation” (DNAR) status may affect physicians' priorities and treatment preferences. The aim of this study was to evaluate whether DNAR status affects the outcomes of septic patients. Methods: This was a retrospective cohort study included septic patients admitted to the emergency department intensive care unit (ED-ICU) in a university-based teaching hospital during April–November 2015. Septic patients admitted to the ED-ICU were included. Results: Of the 132 eligible patients, 49.2% (65/132) had DNAR status (median age 80 years old, IQR, 73–86). The overall in-hospital mortality rate was 28.8% (38/132). Non-survivors had a higher percentage of receiving inotropes/vasopressors (52.6% vs 34.0%, p = 0.048), higher median Charlson comorbidity index scores [8.5 (IQR, 7–11.75) vs 8 (IQR, 6–9), p = 0.012], higher APACHE II score [25 (IQR, 20–30.25) vs 20 (IQR, 17–25), p = 0.002], and higher SOFA score [7 (IQR, 6–11) vs 6 (IQR,4–8), p = 0.012]. There was no significant difference in intubation among the two groups. In a multivariate logistic regression analysis, DNAR status was an independent predictor of in-hospital mortality (odds ratio = 6.22, 95% confidence interval (CI) = (2.71–17.88), p < 0.001). The area under the ROC curve for the logistic regression model was 0.84 [95% CI = (0.77–0.92), p < 0.001]. In subgroup analysis, DNAR status remained an independent predictor of mortality among age ≥65 years and ≥80 years. Conclusion: After adjusting for comorbidities, treatments, and illness severity, DNAR status was associated with in-hospital mortality of septic patients. Further studies should evaluate physicians' attitudes toward septic patients with DNAR status.

AB - Introduction: Sepsis patients require timely and appropriate treatment in an intensive care setting. However, “do-not-attempt resuscitation” (DNAR) status may affect physicians' priorities and treatment preferences. The aim of this study was to evaluate whether DNAR status affects the outcomes of septic patients. Methods: This was a retrospective cohort study included septic patients admitted to the emergency department intensive care unit (ED-ICU) in a university-based teaching hospital during April–November 2015. Septic patients admitted to the ED-ICU were included. Results: Of the 132 eligible patients, 49.2% (65/132) had DNAR status (median age 80 years old, IQR, 73–86). The overall in-hospital mortality rate was 28.8% (38/132). Non-survivors had a higher percentage of receiving inotropes/vasopressors (52.6% vs 34.0%, p = 0.048), higher median Charlson comorbidity index scores [8.5 (IQR, 7–11.75) vs 8 (IQR, 6–9), p = 0.012], higher APACHE II score [25 (IQR, 20–30.25) vs 20 (IQR, 17–25), p = 0.002], and higher SOFA score [7 (IQR, 6–11) vs 6 (IQR,4–8), p = 0.012]. There was no significant difference in intubation among the two groups. In a multivariate logistic regression analysis, DNAR status was an independent predictor of in-hospital mortality (odds ratio = 6.22, 95% confidence interval (CI) = (2.71–17.88), p < 0.001). The area under the ROC curve for the logistic regression model was 0.84 [95% CI = (0.77–0.92), p < 0.001]. In subgroup analysis, DNAR status remained an independent predictor of mortality among age ≥65 years and ≥80 years. Conclusion: After adjusting for comorbidities, treatments, and illness severity, DNAR status was associated with in-hospital mortality of septic patients. Further studies should evaluate physicians' attitudes toward septic patients with DNAR status.

KW - Do-not-attempt resuscitation

KW - Sepsis

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