Determinants of ICU Outcomes in Fully Active Patients Before Critical Illness

Abstract

Aim: To investigate ICU outcomes and early mortality predictors in fully active patients prior to critical illness, a population often considered resilient, yet underrepresented in outcome studies. Materials and Methods: This retrospective cohort study included 139 patients admitted to the medical ICUs of a tertiary hospital between November 2022 and February 2025. Only patients with preserved pre-ICU performance status [Eastern Cooperative Oncology Group (ECOG)≤1 or Clinical Frailty Scale (CFS)≤3] were included. Demographics, comorbidities, admission diagnoses, severity scores (Acute Physiology and Chronic Health Evaluation II [APACHE-II], Sequential Organ Failure Assessment [SOFA]), interventions, and laboratory parameters were recorded. Logistic regression was used to identify the independent predictors for ICU mortality. Results: The ICU mortality rate was 16.5% in fully active critically ill patients. Non-survivors had significantly higher APACHE II and SOFA scores, abnormal laboratory findings, and a greater requirement for mechanical ventilation and renal replacement therapy. Cardiac arrest prior to admission and concominant septic shock were more frequently in non-survivors. ICU admission from inpatient wards (OR 5.69,p=0.023), cardiac arrest before ICU admission (OR 33.45,p=0.002), pulmonary disease as a comorbidity (OR 15.19,p=0.002), concomitant septic shock (OR 5.08,p=0.032), and acute kidney injury (AKI)(OR 10.02,p=0.032) were independent risk factors for ICU mortality, Moreover, SOFA and APACHE II scores showed strong discriminative ability for ICU mortality (AUCs:0.916 and 0.873). Conclusion: Although fully active before critical illness, these patients are not immune to poor ICU outcomes. Our findings highlight that specific clinical presentations like septic shock, cardiac arrest, and AKI carry substantial prognostic value, even in patients considered low-risk by baseline performance.

Keywords

• fully active
• performance status
• ECOG
• clinical fraiilty score
• mortality
• critical illness

Kritik Hastalık Öncesi Performans Durumu Tam Aktif Bireylerin Yoğun Bakım Sonuçlarına Etki Eden Faktörlerinin Değerlendirilmesi

Abstract

Amaç: Bu çalışma ile kritik hastalık öncesinde tam fonksiyonel durumda olan ve bu sebeple fiziki olarak dayanıklı kabul edebileceğimiz hastalarda yoğun bakım sonuçları ve erken mortalite belirteçlerini incelenmeyi amaçlanmıştır. Gereç ve Yöntem: Kasım 2022-Şubat 2025 tarihleri arasında üçüncü basamak bir hastanenin dahili yoğun bakım ünitelerine kabul edilen, kritik hastalık öncesi performans durumu Eastern Cooperative Oncology Group Performance Status (ECOG)≤1 veya Clinical Frailty Scale (CFS)≤3 olan 139 erişkin hasta retrospektif olarak değerlendirildi. Demografik özellikler, komorbiditeler, yatış tanıları, Acute Physiology and Chronic Health Evaluation II (APACHE-II) ve S equential Organ Failure Assessment (SOFA) skorları, organ destek tedavileri ve laboratuvar verileri kaydedildi. Birincil sonlanım noktası yoğun bakım mortalitesi olup, bağımsız belirleyiciler lojistik regresyonla (LR) ile değerlendirildi. Bulgular: Mortalite oranı %16,5 olarak hesaplanan kohortta ölen hastalarda APACHE-II ve SOFA skorları, mekanik ventilasyon ve renal replasman gereksinimleri daha yüksek saptandı. Ölen grupta, servislerden yatış, kabul öncesi kardiyak arrest ve sepsis varlığında şok daha fazla gözlemlendi. LR analizinde servislerden yatış (OR 5.69, p=0.023), kabul öncesi kardiyak arrest (OR 33.45, p=0.002), pulmoner hastalık varlığı (OR 15.19, p=0.002), septik şok varlığı (OR 5.08, p=0.032), ve ABH varlığı (OR 10.02, p=0.032) mortalitenin bağımsız belirleyicileri olarak bulundu. SOFA ve APACHE-II skorları mortaliteyi yüksek doğrulukla öngördü (AUC: 0,916 ve 0,873). Sonuç: Kritik hastalık öncesinde tam fonksiyonel durumda olmalarına rağmen, bu hastalar kötü prognoz riski taşımaktadır. Bulgularımız, septik şok, kardiyak arrest ve akut böbrek hasarı gibi belirli klinik tabloların, başlangıçtaki iyi performans durumuna rağmen düşük riskli kabul edilen hastalarda bile anlamlı prognostik değere sahip olduğunu ortaya koymaktadır.

Keywords

• tam aktif birey
• performans durumu
• ECOG
• klinik kırılganlık skoru
• mortalite kritik hastalık

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