Correlation Between High Sofa and Apache IV Score with Prolonged Length of Stay in ICU of A Tertiary Care Hospital of Eastern India and Long-Term Morbidity and Mortality Evaluation in Elderly Patients – A Prospective Observational Study

INTRODUCTION: More and more intensive care unit (ICU) patients are stabilized during acute illness after extended resuscitation and treatment because of improvements in medical technology and the treatment of conditions like sepsis. These patients grow reliant on intensive care treatments, experience immunological, neuroendocrine, metabolic, and neuromuscular abnormalities, and may need ongoing organ support. These patients are frequently characterized as “chronically critically ill”(1). The emergence of this new patient demographic in the contemporary age presents unique difficulties for prediction, treatment, and health care utilization both in the intensive care unit and after discharge(2). SOFA and APACHE-IV score predict mortality and length of stay in the hospital. Most studies describe this condition using a minimum stay in the intensive care unit, such as 21 or 28 days(3–9). While some studies have utilized the requirement for a tracheostomy, others have particularly looked at patients who required extended mechanical ventilation (24–28 days). However, there is little known about the larger community of hospital survivors who received intensive care. Our study would be useful for to ascertain the correlation between the high SOFA and high APACHE-IV score with duration of stay in the intensive care unit and the long-term mortality rate for older patients who were hospitalized to the ICU and survived until hospital release. OBJECTIVES: To evaluate the correlation between high SOFA and APACHE-IV with the length of ICU stay and 1-year mortality for elderly patients who survived hospital discharge in a tertiary care hospital in eastern India. MATERIAL AND METHODS: A prospective cohort study of a random sample of elderly ICU patients who survived to hospital discharge, with 3, 6, and 12-month follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation, high SOFA score, and APACHE-IV score. RESULTS: Among 1158 elderly patients (mean age-63.3±2) who were admitted to our ICU over the last 14 months, the mean ICU length of stay was 5.04 (±2.5) days. 32 (2.76%) of patients were in the ICU for more than 21 days, representing 88.6% of ICU bed days in the hospital. Their average SOFA score and APACHE-IV were 7.2 and 64.49 respectively and the average hospital mortality prediction was 28.9%. Mechanically ventilated patients increased with increasing length of stay (6.3% for 1–6 days in the ICU and 71.3% for 21+ days). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for more than 21 days, up to 57.8% for patients in the ICU for 28+ days. For each day beyond seven days in the ICU, there was an increased odds of death by 1-year of 1.04 (95% CI 1.03–1.05) irrespective of the need for mechanical ventilation. CONCLUSIONS: For both mechanically ventilated and non-mechanically ventilated patients, with high SOFA and high APACHE-IV scores, there was prolonged ICU stays (>21 days) are linked to greater 1-year death rates. No one cut-off was linked to a distinct plateau or abrupt rise in long-term risk.