Characteristics and outcome of high-cost ICU patients

Figures & data

Table 1 Mean cost of care (USD)

	High cost (n=338)		Non-high cost (n=2,882)		All (3,220)
	n	USD	n	USD	n	USD
Age
0 −17	36	23,074	629	2,492	665	3,606
18–45	80	18,591	713	4,057	793	5,523
46–69	150	18,515	1,085	3,687	1,235	5,488
70–79	65	19,419	364	4,053	429	6,381
>80	7	19,968	91	3,628	98	4,795
Sex
Male	227	18,925	1,745	3,525	1,972	5,298
Female	111	19,831	1,137	3,619	1,248	5,061
Patient outcome
Alive	273	18,573	2,614	3,555	2,887	4,975
Death	65	21,952	268	3,625	333	7,203
Severity
Level I	17	16,549	882	2,706	899	2,967
Level II	39	19,552	738	3,403	777	4,213
Level III	282	19,338	1,262	4,253	1,544	7,008

Table 2 Patient characteristics

	High cost (n=338)	Non-high cost (n=2,882)	P-value
Age (years), mean (SD)	49.8 (22.8)	42.8 (25.8)	<0.001
Category, n (%)
0 −17	36 (5.4)	629 (21.8)	<0.001
18–45	80 (23.7)	713 (24.7)	0.665
46–69	150 (44.4)	1,085 (37.5)	0.016
70–79	65 (19.2)	364 (12.6)	<0.001
>80	7 (2.1)	91 (3.2)	0.271
Sex (male), n (%)	227 (67.2)	1,745 (60.6)	0.018
LOS (median), days (IQR)	13 (10–20)	3 (2–5)	<0.001
Patient outcome (death), n (%)	65 (19.2)	268 (9.3)	<0.001
Severity, n (%)
Level I	17 (5.0)	882 (30.6)	<0.001
Level II	39 (11.5)	738 (25.6)	<0.001
Level III	282 (83.4)	1263 (43.8)
Most responsible diagnostic groups, n (%)
Septicemia	19 (5.6)	88 (3.1)	0.013
Viral and other non bacterial infection	1 (0.3)	134 (4.6)	<0.001
Other Bacterial and parasitic infection	6 (1.8)	24 (0.8)	0.088
Craniotomy	42 (12.4)	227 (7.9)	<0.001
Ventricular shunt	9 (2.7)	30 (1.0)	0.01
Nervous system neoplasm and regenerative diseases	2 (0.6)	24 (0.8)	0.639
Non traumatic intracranial hemorrhage	4 (1.2)	19 (0.6)	0.279
Head trauma	3 (0.9)	29 (1.0)	0.835
Cardiac catheterization	1 (0.3)	76 (2.6)	0.008
Other operations of circulatory system	4 (1.2)	125 (4.3)	0.005
Acute myocardial infarction	1 (0.3)	214 (7.4)	<0.001
Heart failure	3 (0.9)	53 (1.8)	0.206
Unexplained cardiac arrest	4 (1.2)	8 (0.28)	0.010
Simple respiratory system operations	26 (7.7)	55 (1.9)	<0.001
Respiratory infections and inflammation	12 (3.6)	23 (0.8)	<0.001
Simple pneumonia and pertussis	17 (5.0)	194 (6.7)	0.232
Chronic obstructive pulmonary disease	5 (1.5)	46 (1.6)	0.871
Asthma and bronchiolitis	3 (0.9)	59 (2.1)	0.142
Respiratory system signs symptoms and other disorders	9 (2.7)	38 (1.3)	0.051
Complex intestinal operation	22 (6.5)	77 (2.7)	<0.001
Other operation of digestive system	15 (4.4)	61 (2.1)	0.008
Amputation	8 (2.4)	24 (0.8)	0.007
Other ear, nose, mouth, and throat operations	37 (10.9)	34 (1.2)	<0.001

Table 3 Multivariate logistic regression for variables associated with high cost among all patients

Characteristics	Odds ratio	95% CI	P-value
Age
<17
18–45	1.57	1.01–2.46	0.046
46–69	1.68	1.10–2.55	0.015
70–79	2.00	1.24–3.22	0.004
>80	0.76	0.31–1.88	0.563
Sex
Male	1.42	1.09–1.85	0.010
Disease outcome
Death	1.40	0.99–1.97	0.055
Severity level
I
II	2.20	1.22–3.98	0.009
III	8.96	5.32–15.08	<0.001
Most responsible diagnosis
Septicemia	1.60	0.91–2.81	0.104
Viral and other non-bacterial infection	0.12	0.02–0.85	0.034
Other bacterial and parasitic infection	2.26	0.88–5.82	0.091
Craniotomy	3.37	2.21–5.13	<0.001
Ventricular shunt	3.63	1.59–8.29	0.002
Nervous system neoplasm and regenerative diseases	1.44	0.32–6.49	0.639
Non traumatic intracranial hemorrhage	3.70	1.14–12.03	0.029
Head trauma	2.64	0.73–9.51	0.138
Cardiac catheterization	0.16	0.022–1.20	0.075
Other operations of circulatory system	0.50	0.17–1.41	0.188
Acute myocardial infarction	0.05	0.01–0.37	0.003
Heart failure	0.46	0.14–1.51	0.200
Unexplained cardiac arrest	3.53	1.02–12.31	0.047
Simple respiratory system operations	4.92	2.85–8.48	<0.001
Respiratory infections and inflammation	6.44	2.88–14.37	<0.001
Simple pneumonia and pertussis	1.56	0.88–2.78	0.128
Chronic obstructive pulmonary disease	0.82	0.31–2.18	0.695
Asthma and bronchiolitis	0.69	0.21–2.28	0.540
Respiratory system signs symptoms & other disorders	2.70	1.22–5.99	0.014
Complex intestinal operation	3.25	1.87–5.65	<0.001
Other operation of digestive system	2.77	1.46–5.24	0.002
Amputation	2.41	1.03–5.67	0.043
Other ear, nose, mouth, and throat operations	12.78	7.29–22.42	<0.001

Table 4 Multivariate logistic regression for variables associated with high cost among death outcome patient

Characteristics	Odds ratio	95% CI	P-value
Age
<17	Ref
18–45	2.91	0.66–12.76	0.156
46–69	1.50	0.36–6.18	0.578
70–79	3.55	0.77–16.35	0.103
>80	0.90	0.11–7.46	0.919
Sex
Male	1.17	0.56–2.44	0.683
Severity level
I	Ref
II	5.83	0.43–78.82	0.184
III	12.24	1.24–120.18	0.032
Most responsible diagnosis
Septicemia	0.61	0.40–3.39	0.423
Viral and other non-bacterial infection*	-	-	-
Other bacterial and parasitic infection	6.31	0.44–91.58	0.177
Craniotomy	1.67	0.50–5.62	0.402
Ventricular shunt	12.72	1.58–102.63	0.17
Nervous system neoplasm and regenerative diseases*	-	-	-
Non traumatic intracranial hemorrhage	5.38	0.73–39.66	0.099
Head trauma	3.06	0.20–47.01	0.422
Cardiac catheterization*	-	-	-
Other operations of circulatory system*	-	-	-
Acute myocardial infarction*	-	-	-
Heart failure*	-	-	-
Unexplained cardiac arrest	2.08	0.19–22.63	0.549
Simple respiratory system operations	5.60	1.41–22.18	0.014
Respiratory infections and inflammation	3.13	0.49–20.11	0.229
Simple pneumonia and pertussis	1.68	0.52–5.49	0.388
Chronic obstructive pulmonary disease*	-	-	-
Asthma and bronchiolitis*	-	-	-
Respiratory system signs symptoms and other disorders	23.74	0.97–583.06	0.052
Complex intestinal operation	8.95	2.30–34.76	0.002
Other operation of digestive system	8.74	1.98–38.65	0.004
Amputation	6.23	1.18–32.96	0.031
Other ear, nose, mouth, and throat operations*	-	-	-

Note: *No death occurred in these cases.

Abbreviations: ICU, intensive care unit; HCTM, Hospital Canselor Tuanku Muhriz; UKM, Univeristi Kebangsaan Malaysia; MY-DRG, Malaysian diagnosis-related groups.

Data availability

The data that support the findings of this study are available from HCTM but restrictions apply to the availability of these data and are not publicly available. Data are however available from the authors upon reasonable request and with permission of HCTM.