Survival Predictors When Life Support Is Withheld in ICU

Elderly patient in the ICU
Elderly patient in the ICU
Survival at 6 months was significantly associated with acute respiratory failure and history of COPD.

A considerable proportion of patients who were discharged from the intensive care unit (ICU) after life support was withheld survived for ≥6 months, with patients with chronic obstructive pulmonary disease (COPD) having significantly higher survival rates, according to the results of a retrospective study conducted in a 15-bed ICU at the General Public Hospital of Saint-Malo, France, and published in The Clinical Respiratory Journal.1

The investigators sought to examine patient results following ICU and hospital discharge, with their aim being to report 6-month outcomes in discharged patients with treatment limitations in a general ICU and to identify prognostic factors associated with survival. They collected data retrospectively from patients discharged from the ICU and for whom life support was withheld between January 1, 2009, and December 31, 2011. The survival status of all patients at 6 months following discharge and the duration of survival were evaluated.

Of the 1483 patients admitted to the ICU during the study period, 1219 had no treatment limitations and 110 died within 6 months following ICU discharge. All patients from whom life support was withdrawn (n=145) died in the ICU.

A total of 264 patients had life support withheld or withdrawn during their ICU stay and of those, 119 were discharged. Ultimately, 114 participants were included in the study group (5 were excluded because of incomplete data). Patient survival rate at 6 months was 58.8%. Survival was significantly associated with acute respiratory failure (48.0% vs 19.0%, respectively; P =.006), history of COPD (40.0% vs 21.0%, respectively; P =.03), and a lower Simplified Acute Physiology Score2 (SAPS II; 44 vs 49, respectively; P =.006).

Based on results of multivariate analysis, COPD was identified as a statistically significant prognostic factor for survival (hazard ratio, 2.1; 95% CI, 1.02-4.36; P =.04).

The investigators concluded that the decision to withhold life-sustaining treatments should not lead to a cessation of post-ICU follow-up care. Patients with COPD who decide to withhold endotracheal intubation may nonetheless benefit from readmission to the ICU.

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  1. Maamar A, Chevalier S, Fillâtre P, et al. COPD is independently associated with six-month survival in patients who have life support withheld in intensive care [published online April 16, 2018]. Clin Respir J. doi:10.1111/crj.12899
  2. Le Gall J-R, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957-2963.