The following is a summary of “Mortality rates among adult critical care patients with unusual or extreme values of vital signs and other physiological parameters: a retrospective study,” published in the May 2024 issue of Critical Care by Harding et al.
Researchers conducted a retrospective study identifying the associations between in-hospital mortality and extreme or unusual values of vital signs and lab results in patients with critical illness.
They analyzed data from Philips Healthcare–MIT eICU data, encompassing 166,959 adult critical care admissions across 207, U.S. hospitals (2014 to 2015). The main focus was on the deranged values recorded within the first 24 hours of admission for various physiological parameters, including vital signs (body temperature, heart rate, mean arterial pressure, and respiratory rate) and laboratory tests, albumin, bilirubin, blood pH, blood urea nitrogen, creatinine, FiO2 glucose, hematocrit, PaO2, PaCO2, sodium, 24-hour urine output, and white blood cell count (WBC).
The result showed a significant association between in-hospital mortality and extreme values of specific physiological parameters. The in-hospital mortality rates reached or exceeded 50% for patients with very low blood pH, abnormally low or high body temperature, low albumin levels, low blood sugar, and a slow heart rate. Slight variations in measured values were associated with several-fold increases in mortality rates. A common practice of categorizing physiological parameters masked the high and sudden increase in death rates. Blood pH, body temperature, and FiO2 emerged as the strongest predictors of in-hospital mortality, with scaled Brier scores of 0.084, 0.063, and 0.049, respectively.
Investigators concluded that extreme vital signs and lab values strongly predicted mortality in critical care despite being undervalued due to common practice and ease of obtaining vital signs.
Source: accjournal.org/journal/view.php?number=1526
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