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Original Article
- Epidemiology
- Mortality rates among adult critical care patients with unusual or extreme values of vital signs and other physiological parameters: a retrospective study
- Charles Harding, Marybeth Pompei, Dmitriy Burmistrov, Francesco Pompei
- Acute Crit Care. 2024;39(2):304-311. Published online May 13, 2024
- DOI: https://doi.org/10.4266/acc.2023.01361
- 13,613 View
- 170 Download
- 3 Web of Science
- 4 Crossref
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Abstract
PDF - Background
We evaluated relationships of vital signs and laboratory-tested physiological parameters with in-hospital mortality, focusing on values that are unusual or extreme even in critical care settings.
Methods
We retrospectively studied Philips Healthcare–MIT eICU data (207 U.S. hospitals, 20142015), including 166,959 adult-patient critical care admissions. Analyzing most-deranged (worst) value measured in the first admission day, we investigated vital signs (body temperature, heart rate, mean arterial pressure, and respiratory rate) as well as albumin, bilirubin, blood pH via arterial blood gas (ABG), blood urea nitrogen, creatinine, FiO2 ABG, glucose, hematocrit, PaO2 ABG, PaCO2 ABG, sodium, 24-hour urine output, and white blood cell count (WBC).
Results
In-hospital mortality was ≥50% at extremes of low blood pH, low and high body temperature, low albumin, low glucose, and low heart rate. Near extremes of blood pH, temperature, glucose, heart rate, PaO2 , and WBC, relatively. Small changes in measured values correlated with several-fold mortality rate increases. However, high mortality rates and abrupt mortality increases were often hidden by the common practice of thresholding or binning physiological parameters. The best predictors of in-hospital mortality were blood pH, temperature, and FiO2 (scaled Brier scores: 0.084, 0.063, and 0.049, respectively).
Conclusions
In-hospital mortality is high and sharply increasing at extremes of blood pH, body temperature, and other parameters. Common-practice thresholding obscures these associations. In practice, vital signs are sometimes treated more casually than laboratory-tested parameters. Yet, vitals are easier to obtain and we found they are often the best mortality predictors, supporting perspectives that vitals are undervalued. -
Citations
Citations to this article as recorded by
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BMC Medicine.2025;[Epub] CrossRef
- SAPS II or APACHE II is better to predict mortality in patients admitted at ICU
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