Practice and Predictors of Do-Not-Resuscitate Orders in a Tertiary-Care Intensive Care Unit in Saudi Arabia
Table 1
Baseline characteristics of patients with do-not-resuscitate (DNR) status and patients with full code status.
Variables
All N = 24790
Do-not-resuscitate (DNR) N = 3217
Full code N = 21573
value
Demographics
Age (yrs), median (Q1, Q3)
58 (35, 72)
67 (55, 76)
57 (33, 71)
<0.0001
Male sex, n (%)
15216 (61.4)
1843 (57.3)
13373 (62)
<0.0001
Female sex, n (%)
9574 (38.6)
1374 (42.7)
8200 (38.0)
Pre-morbid WHO performance status score
0
11847 (47.8)
934 (29.1)
10913 (50.6)
<0.0001
1
3744 (15.1)
467 (14.5)
3277 (15.2)
2
3681 (14.9)
624 (19.4)
3057 (14.2)
3
3013 (12.2)
584 (18.2)
2429 (11.3)
4 and 5
2500 (10.1)
606 (18.9)
1894 (8.8)
Admission category, n (%)
Respiratory
4754 (19.2)
598 (18.6)
4156 (19.3)
<0.0001
Cardiovascular
8507 (34.4)
1729 (53.8)
6778 (31.5)
Neurologic
2168 (8.8)
318 (9.9)
1850 (8.6)
Other medical
1391 (5.6)
206 (6.4)
1185 (5.5)
Nonoperative trauma
2673 (10.8)
120 (3.7)
2553 (11.9)
Postoperative
5273 (21.3)
246 (7.7)
5027 (23.3)
Sepsis, n (%)
9488 (38.3)
1539 (47.8)
7949 (36.9)
<0.0001
Ischemic stroke, n (%)
2603 (10.5)
530 (16.5)
2073 (9.6)
<0.0001
Hemorrhage stroke, n (%)
2789 (11.3)
325 (10.1)
2464 (11.4)
0.03
Chronic comorbidities, n (%)
Chronic cardiovascular disease
4807 (19.5)
753 (23.6)
4054 (18.9)
<0.0001
Chronic liver disease
1938 (7.9)
616 (19.3)
1322 (6.2)
<0.0001
Chronic respiratory disease
3457 (14.01)
469 (14.7)
2988 (13.9)
0.23
Chronic renal disease
2531 (10.3)
516 (16.2)
2015 (9.4)
<0.0001
Immunocompromised status
2516 (10.2)
595 (18.6)
1921 (8.9)
<0.0001
Diabetes
8952 (36.1)
1379 (42.9)
7573 (35.1)
<0.0001
Laboratory and clinical findings in the first 24 hours
APACHE II score, median (Q1, Q3)
20 (14, 27)
28 (23, 34)
19 (13, 14)
<0.0001
Bilirubin (mmol/L), median (Q1, Q3)
14 (9, 29)
21 (11, 58)
14 (8, 27)
<0.0001
GCS, median (Q1, Q3)
13 (8, 15)
8 (3, 13)
14 (9, 15)
<0.0001
Creatinine (μmol/L), median (Q1, Q3)
89 (61, 174)
139 (80, 248)
84 (60, 159)
<0.0001
Lactic acid, median (Q1, Q3)
2 (1.2, 3.6)
3.1 (1.7, 6.9)
1.9 (1.2, 3.3)
<0.0001
INR, median (Q1, Q3)
1.2 (1.1, 1.5)
1.4 (1.2, 2.1)
1.2 (1.1, 1.5)
<0.0001
PaO2/FiO2 ratio, median (Q1, Q3)
235 (148, 342)
173 (107, 267)
243 (155, 348)
<0.0001
Therapies during ICU stay
Mechanical ventilation, n (%)
14531 (58.6)
2660 (82.7)
11871 (55.0)
<0.0001
Renal replacement therapy, n (%)
3706 (14.95)
958 (29.8)
2748 (12.7)
<0.0001
Admission year
≤2005
4915 (19.8)
932 (29)
3983 (18.5)
<0.0001
2006–2011
6079 (24.5)
994 (30.9)
5085 (23.6)
2012–2017
13796 (55.7)
1291 (40.1)
12505 (58)
APACHE II: acute physiology and chronic health evaluation II; GCS: glasgow coma score; INR: internal normalized ratio; PaO2/FiO2 ratio: the ratio of the partial pressure of oxygen to the fraction of inspired oxygen. 0: able to carry out all normal activity without restriction; 1: restricted in strenuous activity but ambulatory and able to carry out light work; 2: ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours; 3: symptomatic and in a chair or in bed for greater than 50% of the day but not bedridden; 4: completely disabled; cannot carry out any self-care; totally confined to bed or chair; 5: dead; Q1: first quartile, Q3: third quartile; For all percentages, the denominator is the total number of subjects in the group. Continuous variables were compared using T-Test and categorical value using Chi-square test. Cardiovascular reasons for ICU admission as defined by the APACHE II system include cardiovascular failure of insufficiency due to hypertension, rhythm disturbance, hemorrhagic shock/hypovolemia, coronary artery disease, sepsis, postcardiac arrest, cardiogenic shock and pulmonary embolism. One patient may have more than one comorbid condition. defined as receiving therapy that suppresses resistance to infection (e.g., immunosuppression, chemotherapy, radiation, long-term or high-dose steroids, or advanced leukemia, lymphoma, cancer, or AIDS).
