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Article: Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018

TitleCharacteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018
Authors
KeywordsIntensive care
APACHE IV
Benchmarking
Hong Kong
Standard mortality ratio
Issue Date2021
PublisherBioMed Central Ltd. The Journal's web site is located at https://jintensivecare.biomedcentral.com/
Citation
Journal of Intensive Care, 2021, v. 9, article no. 2 How to Cite?
AbstractBackground: Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods: This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results: From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions: Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.
Persistent Identifierhttp://hdl.handle.net/10722/306498
ISSN
2023 Impact Factor: 3.8
2023 SCImago Journal Rankings: 1.269
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLing, L-
dc.contributor.authorHo, CM-
dc.contributor.authorNg, PY-
dc.contributor.authorChan, KCK-
dc.contributor.authorShum, HP-
dc.contributor.authorChan, CY-
dc.contributor.authorYeung, AWT-
dc.contributor.authorWong, WT-
dc.contributor.authorAu, SY-
dc.contributor.authorLeung, KHA-
dc.contributor.authorChan, JKH-
dc.contributor.authorChing, CK-
dc.contributor.authorTam, OY-
dc.contributor.authorTsang, HH-
dc.contributor.authorLiong, T-
dc.contributor.authorLaw, KI-
dc.contributor.authorDharmangadan, M-
dc.contributor.authorSo, D-
dc.contributor.authorChow, FL-
dc.contributor.authorChan, WM-
dc.contributor.authorLam, KN-
dc.contributor.authorChan, KM-
dc.contributor.authorMok, OF-
dc.contributor.authorTo, MY-
dc.contributor.authorYau, SY-
dc.contributor.authorChan, C-
dc.contributor.authorLei, E-
dc.contributor.authorJoynt, GM-
dc.date.accessioned2021-10-22T07:35:28Z-
dc.date.available2021-10-22T07:35:28Z-
dc.date.issued2021-
dc.identifier.citationJournal of Intensive Care, 2021, v. 9, article no. 2-
dc.identifier.issn2052-0492-
dc.identifier.urihttp://hdl.handle.net/10722/306498-
dc.description.abstractBackground: Globally, mortality rates of patients admitted to the intensive care unit (ICU) have decreased over the last two decades. However, evaluations of the temporal trends in the characteristics and outcomes of ICU patients in Asia are limited. The objective of this study was to describe the characteristics and risk adjusted outcomes of all patients admitted to publicly funded ICUs in Hong Kong over a 11-year period. The secondary objective was to validate the predictive performance of Acute Physiology And Chronic Health Evaluation (APACHE) IV for ICU patients in Hong Kong. Methods: This was an 11-year population-based retrospective study of all patients admitted to adult general (mixed medical-surgical) intensive care units in Hong Kong public hospitals. ICU patients were identified from a population electronic health record database. Prospectively collected APACHE IV data and clinical outcomes were analysed. Results: From 1 April 2008 to 31 March 2019, there were a total of 133,858 adult ICU admissions in Hong Kong public hospitals. During this time, annual ICU admissions increased from 11,267 to 14,068, whilst hospital mortality decreased from 19.7 to 14.3%. The APACHE IV standard mortality ratio (SMR) decreased from 0.81 to 0.65 during the same period. Linear regression demonstrated that APACHE IV SMR changed by − 0.15 (95% CI − 0.18 to − 0.11) per year (Pearson’s R = − 0.951, p < 0.001). Observed median ICU length of stay was shorter than that predicted by APACHE IV (1.98 vs. 4.77, p < 0.001). C-statistic for APACHE IV to predict hospital mortality was 0.889 (95% CI 0.887 to 0.891) whilst calibration was limited (Hosmer–Lemeshow test p < 0.001). Conclusions: Despite relatively modest per capita health expenditure, and a small number of ICU beds per population, Hong Kong consistently provides a high-quality and efficient ICU service. Number of adult ICU admissions has increased, whilst adjusted mortality has decreased over the last decade. Although APACHE IV had good discrimination for hospital mortality, it overestimated hospital mortality of critically ill patients in Hong Kong.-
dc.languageeng-
dc.publisherBioMed Central Ltd. The Journal's web site is located at https://jintensivecare.biomedcentral.com/-
dc.relation.ispartofJournal of Intensive Care-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectIntensive care-
dc.subjectAPACHE IV-
dc.subjectBenchmarking-
dc.subjectHong Kong-
dc.subjectStandard mortality ratio-
dc.titleCharacteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018-
dc.typeArticle-
dc.identifier.emailNg, PY: pyeungng@hku.hk-
dc.identifier.emailChan, WM: drchanwm@hkucc.hku.hk-
dc.identifier.authorityNg, PY=rp02517-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1186/s40560-020-00513-9-
dc.identifier.pmid33407925-
dc.identifier.pmcidPMC7788755-
dc.identifier.scopuseid_2-s2.0-85098749980-
dc.identifier.hkuros328526-
dc.identifier.volume9-
dc.identifier.spagearticle no. 2-
dc.identifier.epagearticle no. 2-
dc.identifier.isiWOS:000608127000001-
dc.publisher.placeUnited Kingdom-

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