Sobrevida y sus determinantes en los pacientes ingresados en las unidades de cuidado intensivo en un hospital terciario durante el año 2023

Abstract

Aim: To describe the epidemiological profile, the incidence of organ dysfunction and organ support at admission, as well as survival and factors associated with reduced survival among patients admitted to the intensive care units of Hospital México during 2023. Methods: Observational, descriptive cohort study based on a retrospective review of clinical data available in the institutional database of the Intensive Care Service of Hospital México, a tertiary-level general hospital within the Costa Rican Social Security System. All patients admitted between January 1 and December 31, 2023, with a length of stay greater than 24 hours were included. Demographic variables, comorbidities, organ dysfunctions at admission, and need for organ support were analyzed. Mortality was verified through review of the electronic medical record and the Civil Registry of Costa Rica. Survival was estimated using the Kaplan–Meier method at the in-hospital level, at 28 days, and at 180 days. Hazard ratios (HR) were calculated using Cox proportional hazards regression to identify factors associated with mortality. Results: A total of 965 patients were included, with a median age of 54 years (P25–P75: 41–67); 61.8% were men, and 27.0% were aged 65 years or older. The median SOFA score was 5 (P25–P75: 1–9). The most frequent comorbidities were hypertension (43.9%), heart disease (20.7%), and diabetes mellitus (21.0%), none of which were significantly associated with ICU mortality. ICU survival was 83.4% (adjusted 85.7%), 28-day survival was 80.2%, and 180-day survival was 68.2%. In multivariable analysis, lower survival was associated with shock at admission (HR 5.3; 95% CI 3.5–8.2), acute kidney injury (HR 4.7; 95% CI 3.3–6.7), sepsis (HR 3.0; 95% CI 2.2–4.2), acute gastrointestinal injury (HR 3.0; 95% CI 1.9–4.8), and acute respiratory distress syndrome (HR 2.9; 95% CI 2.0–4.1). The need for vasopressors (HR 14.7; 95% CI 7.2–30.0; p<0.001), mechanical ventilation (HR 11.9; 95% CI 5.6–33.7), and renal replacement therapy (HR 3.3; 95% CI 2.3–4.7) was associated with a significantly higher risk of death. Conclusions: Overall survival among critically ill patients at Hospital México during 2023 was 83% in the ICU, 80% at 28 days, and 68% at 180 days. No comorbidity at admission was associated with reduced survival. Acute organ dysfunction syndromes, particularly shock, acute kidney injury, sepsis, and acute respiratory distress syndrome, were associated with lower survival. The requirement for vasopressor support, mechanical ventilation, or renal replacement therapy had the greatest negative impact on survival.