Ten-year trends in non-surgical patients requiring intensive care: Long-term prognostic differences by year of admission

Abstract

Background

The aim of the present study is to elucidate prognostic impact of temporal trends of non-surgical patients requiring intensive care over a 10-year period.

Methods and Results

A total of 4276 non-surgical patients requiring intensive care from 2012 to 2021 were enrolled. Patients' backgrounds, in-hospital management, and prognoses were compared between five groups [2012–2013 (n = 825), 2014–2015 (n = 784), 2016–2017 (n = 864), 2018–2019 (n = 939), and 2020–2021 (n = 867)]. During the study period, mean age significantly increased from 69 years in 2012–2013 to 72 years in 2020–2021. Mean Acute Physiology and Chronic Health Evaluation scores significantly increased from 10 points in 2012–2013 to 12 points in 2020–2021. The median duration of intensive care unit stays increased from 3 to 4 days. Kaplan-Meier survival curve analysis showed that survival rates during 30- and 365-days were significantly lower in 2020–2021 than in 2012–2013, but it was not significantly different by a Cox proportional hazards regression model in 30 days. A Cox proportional hazards regression model revealed that the risks of 365-day all-cause death were significantly higher in patients enrolled in 2016–2017 (HR: 1.324, 95 % CI: 1.042–1.680, p = 0.021), in 2018–2019 (HR: 1.329, 95 % CI: 1.044–1.691, p = 0.021), and in 2020–2021 (HR: 1.409, 95 % CI: 1.115–1.779, p = 0.004).

Conclusion

The condition of patients requiring intensive care is becoming more critical year by year, leading to poorer long-term prognoses despite improvements in treatment strategies. These findings emphasize the importance of additional care management after admission into non-surgical intensive care units, particularly for the aging society of Japan.