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IntensiveCareMed(2017)43:1745–1746DOI10.
1007/s00134-017-4883-0CORRESPONDENCEMortalityrateinPolishintensivecareunitsislowerthanpredictedaccordingtotheAPACHEIIscoringsystemPiotrKnapik1*,ukaszJ.
Krzych2,WojciechWeigl3,JanAdamski4andMichaelHultstm3,52017TheAuthor(s).
ThisarticleisanopenaccesspublicationInitialcorrespondencefromDrs.
KnapikandKrzychDearEditor,WereadwithinteresttheletterrecentlypublishedbyWeigletal.
inIntensiveCareMedicine[1].
Basedontheinformationinthisletter,thereadermayassume—wrongly—thatthelevelofintensivecareunit(ICU)servicesinPolandisinsufficienttoguaranteeoptimalpatientcare.
However,highermortalityinPolishICUsisinfactduetoprofounddifferencesinpatientpopula-tions,availabilityofICUbeds,indicationsforICUadmis-sionandorganisationofend-of-lifecareinPoland,incomparisontootherEuropeancountries.
Additionally,theofficialPolishSocietyguidelinesonfutiletherapy[2]andoncriteriaofICUadmissionarestillignoredbymanyintensivistsduetouncertainityregardingthelegalconsequencesand/orpressurefromotherdepartmentsandthehospitaladministration.
BasedonouranalysisofdatafromtheSilesianReg-istryofIntensiveCareUnits[3],wecanclearlydem-onstratethatmanypatientsadmittedtoPolishICUswereatthehighestriskofdeathbutthatICUmortal-itywasevenlowerthanthatpredictedbytheAPACHEIIscoringsystem,especiallywithinthehighestvalues(Fig.
1).
Overallpredictedmortalityforthispopulationwas47%andtheobserved-to-predictedmortalityratiowas0.
93.
Insummary,interpretationofdemographicindicesacrosscountriesmustalwaysbeperformedwithextremecautionandwithtakingintoaccountallpotentialconfounders.
WefullysupportthenotionofWeigletal.
tostimulateimprovementofcriticalcareservicesinPolandandexpandingthealreadyexistingregionaldata-basetoanationalregistry.
ReplyfromDrs.
Weigl,AdamskiandHultstmWewouldliketothankProfessorKnapikandProfes-sorKrzychfortheircommentsbasedondatafromtheSilesianRegistryofIntensiveCareUnitsinPoland.
ThehighmortalityratesobtainedfromthePolishICUscitedinourletter[1]doesindeedcallintoquestionissuessuchasqualityofcareandend-of-lifeguidelines.
Thedataonalargenumberofmechanicallyventilatedpatients,highseverityofillnessscores,andsatisfactoryratioofobservedtopredictedmortality,whichhavebeenreportedbyKnapikandKrzych,contributetothediscus-siononboththepotentialriskfactorsandlevelofservice,andareinlinewithourpreviousfindings[4].
Assuch,weagreethatthehighmortalityratesinPolishICUscannotbesimplyinterpretedasresultsoflowqualityofcare.
Inaddition,weareawarethatthePolishguidelinesregardingICUtriagehavebeenpublished.
However,asKnapikandKrzychnoted,theextenttowhichthesearebeingfollowedisunknown.
TheimportantpointwewishedtomakeisthattheseguidelinesarenotsupportedbyeitherPolishlegislationorbytheorganizationofend-of-lifecareinPoland.
Inconclusion,thereasonsforhighICUmortalityinPolandneedtobefurtherinvestigatedandshouldbeaddressedproperly.
WeareencouragedbytheactivityoftheSilesianregionalICUregistryandlookforwardtopublicationoftheirresults.
However,weareconfi-dentthatthefuturedevelopmentofintensivecareinPolandrequiresanationalregistrythatcouldprovidean*Correspondence:kardanest@sum.
edu.
pl1DepartmentofCardiacAnesthesiaandIntensiveCare,SilesianCentreofHeartDiseases,MedicalUniversityofSilesia,Zabrze,PolandFullauthorinformationisavailableattheendofthearticle1746impetusforchangeinPolishlegislationandhealthcareorganization.
Authordetails1DepartmentofCardiacAnesthesiaandIntensiveCare,SilesianCentreofHeartDiseases,MedicalUniversityofSilesia,Zabrze,Poland.
2DepartmentofAnaesthesiologyandIntensiveCare,MedicalUniversityofSilesia,Katowice,Poland.
3AnaesthesiologyandIntensiveCare,DepartmentofSurgicalSci-ences,AkademiskaHospital,UppsalaUniversity,75185Uppsala,Sweden.
4DepartmentofAnaesthesiaandIntensiveCare,SatakuntaDistrictHospital,28500Pori,Finland.
5IntegrativePhysiology,DepartmentofMedicalCellbiol-ogy,UppsalaUniversity,75123Uppsala,Sweden.
CompliancewithethicalstandardsConflictsofinterestTheauthorsdeclarethattheyhavenocompetinginterests.
OpenAccessThisarticleisdistributedunderthetermsoftheCreativeCommonsAttribu-tion-NonCommercial4.
0InternationalLicense(http://creativecommons.
org/licenses/by-nc/4.
0/),whichpermitsanynoncommercialuse,distribution,andreproductioninanymedium,providedyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicense,andindicateifchangesweremade.
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AnaesthesiolIntensiveTher47:117–124Fig.
1Predicted-to-observedmortalityratiointheSilesianRegistryofIntensiveCareUnits.
APACHEIIAcutePhysiologyandChronicHealthEvalua-tionII