Determinants of limitations in life-sustaining treatment in a Norwegian intensive care unit

Background: To withhold or withdraw treatment are important decisions made in intensive care units (ICUs). Few studies have investigated the association between clinical variables available after 24 hours in the ICU and decisions to limit life-sustaining treatment. Objectives: To assess factors associated with limitations in life-sustaining treatment in a general ICU, from 2007 to 2009 in a university hospital in Norway. Methods: During the first 24 hours in the ICU patients had age, sex, Simplified Acute Physiology Score II (SAPS II), type of admission, and length of hospital stay prior to ICU admission registered. We retrospectively registered Charlson Comorbidity Index (CCI) for all patients, based on the medical records prior to the index stay. A multivariate logistic regression analysis was used to assess determinants of limitations in treatment (withholding or withdrawing treatment) during the ICU stay. Results: In total, 1035 patients were included; 766 (74%) medical, 221 (21%) unscheduled surgical, and 48 (5%) scheduled surgical patients. Overall, 256 patients (25%) had limitations in treatment during the ICU stay. In multivariate analysis (n=1035), older age (OR 1.68 per 10 years), higher SAPS II score (OR 1.05), and higher CCI (OR 1.19) were significantly associated with limitations in treatment (p Conclusion: In multivariate analysis, age, severity of illness, comorbidity and length of stay prior to ICU admission were associated with subsequent limitations in life-sustaining treatment during the ICU stay.