Miller and colleagues Ganetespib Sigma [4] found that the overall mortality rate was 22% with the majority of patients dying from MOF. Age was the only significant predictor of mortality. In both these studies, pre-existing conditions were not analyzed. Goins and colleagues [5] reported a mortality rate of 17% for 87 trauma patients spending more than 30 days in the ICU. There was no comparison to a control group.In contrast to the above-mentioned studies, our study was unique in that we analyzed differences in pre-existing conditions and acquired complications. We found that ILOS>30 patients constituted only a small percentage of all trauma admissions to the ICU but consumed a disproportionately large amount of ICU resources. These findings are similar to a prospective study by Martin and colleagues where in a heterogeneous population, prolonged-stay patients represented 5.

6% of ICU admissions and accounted for almost 40% of bed days [6]. Similarly, medical-surgical ICU patients with ICU LOS of more than 30 days accounted for 8% of total ICU admissions but 48% of occupied beds [7] in another study.Not surprisingly, age and injury severity were associated with prolonged ICU stay and mortality, but after multivariate analysis, age was not found to be an independent predictor of prolonged stay, and neither were pre-existing conditions or admission GCS. Instead, sepsis, ARDS and other infectious complications were found to be powerful predictors.That age or pre-existing conditions did not independently predict prolonged stay could simply be attributed to selection bias: older patients and those with significant pre-existing conditions may not have survived to the 30-day mark.

This is suggested by comparing those who died before 30 days to the ILOS>30 patients: patients who died before 30 days of admission were older, and more likely to have a significant head injury, pre-existing cardiac or neurological condition and be on warfarin. Notably, in ILOS<30 non-survivors, 61% were aged 65 years or older versus 39% in the ILOS>30 group.Within the ILOS>30 group, similar to the previous studies on trauma patients, we found that age was still an independent predictor of mortality. In addition, pre-existing renal conditions and the need for renal replacement therapy during the ICU stay also predicted mortality. The high mortality rates associated with dialysis have been reported in other institutions [2,7,8].

The study by Eachempati and colleagues [8] demonstrated a mortality rate of 61% in patients requiring dialysis compared with an overall mortality of 45% for all patients with acute renal failure. Patients who required dialysis in our study had a mortality rate of 33%.The Dacomitinib mortality rate in the ILOS>30 trauma patients (12%) was consistent with the previously published studies on trauma patients.