![Page 1: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/1.jpg)
Prognostische Implikationen
Nosokomialer Infektionen
Univ. Prof. Dr. A. Valentin, MBA
Kardinal Schwarzenberg Klinikum
Schwarzach i. Pongau
![Page 2: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/2.jpg)
Zarb P, Euro Surveill 2012
28.1% ICU
20.000 pts, 66 hospitals, 23 countries
![Page 3: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/3.jpg)
Verlauf einer kritischen Erkrankung
Grafik nach Cook D: Int Care Med, 2003
Nosokomiale Infektion
![Page 4: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/4.jpg)
Prognostic Impact
Outcome: Hospital Mortality
![Page 5: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/5.jpg)
Prognostic Impact
Previous health status
45%
ICU admission20%
Acute physiology
25%
NosocomialInfection ?
Outcome: Hospital Mortality
![Page 6: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/6.jpg)
Attributable Mortality
Mortalitätsrisiko
Kritische Erkrankung
Mortalitätsrisiko
Nosokomiale Infektion
Gesamtes
Mortalitäts risiko
![Page 7: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/7.jpg)
1-5 Year Hazard Ratio 1-10 Year Mortality Rate
Group HR (95% CI) Cohort (%) General population (%)
Severe sepsis/shock All Age <60
60-70 >70
Any comorbidity No Yes
4.5 (2.2.-9.1)
17.8 (13.4-23.8)
5.5 (3.6-8.5)
2.4 (1.3-4.4)
2.9 (1.7-3.8)
7.5 (3.6-15.5)
30.5 24.4 37.4 44.4
21.6 44.1
11.8 2.7 12.3 28.0
12.0 11.6
Critically ill, nonseptic All Age <60
60-70 >70
4.1 (2.6-6.5)
13.0 (6.8-25.1)
6.1 (3.0-12.2)
3.0 (1.3-6.8)
22.1 12.6 31.4 52.6
10.5 2.2 12.3 29.4
Cardiovascular surgery All Age <60
60-70 >70
1.2 (0.9-1.6) 2.2 (1.1-4.2)
1.4 (0.9-2.2)
0.9 (0.6-1.4)
15.9 5.9 15.0 25.9
14.8 4.1 12.5 26.3
Linder A, Crit Care Med 2014
![Page 8: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/8.jpg)
![Page 9: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/9.jpg)
Methodische Fragestellungen
• Definition Nosokomial
– (Bsp.VAP)
• Health aquired infection
(wann, wo?)
– Hospital acquired
– ICU acquired
• Lokalisation
– Blutstrom
– Lunge
– Urogenital
– Andere
• Quelle
– Katheter, Drains
– Tubus
– Übertragung
– ……….
• Outcome
– ICU
– Hospital
– Long-term
![Page 10: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/10.jpg)
Klinischer
Verlauf vor
Nosokomialer
Infektion
• 44 Patienten mit NI
• 44 Pat. ohne NI
• 123 Variable für
Matching
• 96% Übereinstimmung
Girou E, Am J Respir Crit Care Med 1998
![Page 11: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/11.jpg)
Methodik: gematchte Kontrollen
Garrouste-Orgeas M, Clin Infect Dis 2006
![Page 12: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/12.jpg)
Nosokomiale Infektionen und Infektionen mit
multiresistenten Erregern – Häufigkeit und Sterblichkeit
Gastmeier P, Dtsch Med Wochenschr 2016
≈ 3%
![Page 13: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/13.jpg)
Nosokomiale Infektionen und Mortalität
Assoziation ? Kausalität?
Daten aus EPIC Studie, JAMA 1995
Vincent JL, Lancet 2003
![Page 14: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/14.jpg)
International study of the prevalence and outcomes of
infection in intensive care units
(EPIC II)
• 1265 ICUs
• 75 countries
• 13796 adult patients
• Antibiotics: 71%
• Infected: 51%
Not
infected
Infected
p
ICU Mortality 11% 25% <0.001
Hospital Mortality 15% 33% <0.001
OR 1 1.51 <0.001
Vincent JL, JAMA 2009
![Page 15: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/15.jpg)
BLOODSTREAM INFECTION
![Page 16: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/16.jpg)
Hospital-acquired
bloodstream infections
Barnett A.G, BMJ 2013
![Page 17: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/17.jpg)
Clinical outcomes of health-care-associated infections and
antimicrobial resistance in patients admitted to European
intensive-care units
Lambert M, Lancet Infect Dis 2011
Bloodstream Infection
![Page 18: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/18.jpg)
ICU-acquired
bloodstream
infection
• 10.041 pts
≥ 72h in ICU
• 5,7% with
at least
one ICU-BSI
• Overall increase
in 30 d
mortality risk
with ICU-BSI
was 40%
Adrie C, J Infect, 2017
![Page 19: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/19.jpg)
Determinants of Outcome in Hospitalized Patients
with MRSA Bloodstream Infection
Variables Associated With
30-Day All-Cause Mortality
• Age
• Pleuropulmonary Infection
• Transfer to ICU
• Failure to receive appropriate
definitive antimicrobial therapy
Simor AE
Infect Control Hosp Epidemiol
2016
![Page 20: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/20.jpg)
ICU acquired BSI
• 6339 ICU admissions (2 Australian hospitals)
• BSI after ≥ 72h in 5.2%
• Mortality with ICU-BSI: + 19%
• Absolute decrease in survival of 1% in the total population
Risk for ICU-BSI Hospital survival
Prowle JR, Crit Care 2011
![Page 21: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/21.jpg)
ICU acquired BSI
Prowle JR, Crit Care 2011
Time-Dependency Overall Impact
![Page 22: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/22.jpg)
PNEUMONIE
![Page 23: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/23.jpg)
Clinical outcomes of health-care-associated infections and
antimicrobial resistance in patients admitted to European
intensive-care units
Lambert M, Lancet Infect Dis 2011
Pneumonia
![Page 24: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/24.jpg)
COPD patients with ventilator-associated pneumonia
COPD
(n=397)
Without COPD
(n=1685)
VAP (%) 19.9 19.7 n.s.
SAPS II (points; median) 45 46 n.s.
ICU mortality (%) 34.5 37.4 n.s.
a secondary analysis of the European (EU)-VAP/ CAP database
Koulenti D, Eur J Clin Microbiol Infect Dis 2015
![Page 25: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/25.jpg)
ICU acquired pneumonia:
monomicrobial vs. polymicrobial
• 441 consecutive pts with ICUAP
• 58% microbiological confirmation
• 16% polymicrobial pneumonia
Ferrer M, Crit Care 2015
![Page 26: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/26.jpg)
UROGENITALTRAKT
![Page 27: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/27.jpg)
Catheter-associated urinary tract infetion
Chant C, Crit Care Med 2011
![Page 28: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/28.jpg)
SPEZIFISCHE FRAGESTELLUNGEN
![Page 29: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/29.jpg)
EUROBACT Study
ICU patients with hospital aquired fungemia
• Fungemia in 8.3%
of HA-BSI
• Fungemia already at
ICU admission: 23%
• 28 day mortality:
– Fungemia 41%
– Bacteremia 35%
Paiva JA, Crit Care 2016
![Page 30: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/30.jpg)
Association of nosocomial infections with delayed cerebral
ischemia in aneurysmal subarachnoid hemorrhage
Foreman PM, J Neurosurg 2016
![Page 31: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/31.jpg)
Colonization and infection with ESBL-producing
Enterobacteriaceae (ESBL-PE) in ICU patients
• ESBL-PE infections increased
– carbapenem consumption
– LOS
– day 28 mortality
Barbier F, J Antimicrob Chemotherap 2016
• ESBL-PE carriage increased
– carbapenem consumption
– LOS
![Page 32: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/32.jpg)
ICU aquired infections and age
Without ICU
aquired
infection
With ICU
aquired
infection
Age
<80
Age
≥80
Age
<80
Age
≥80
ICU mortality (%) 21 33 52 68
HR for death 1.0 1.0 2.5 2.1
Maillet JM, J Hosp Infect 2014
1410 pts with ICU stay >3 days
Age: 18.9% ≥ 80 years
![Page 33: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/33.jpg)
WAS BEDEUTET DAS ALLES ?
![Page 34: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/34.jpg)
Admission Diagnosis
Sepsis
Admission Diagnosis
Non-Infectious
Van Vught L.A., JAMA 2016
![Page 35: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/35.jpg)
Long-Term Mortality After Pneumonia in Cardiac
Surgery Patients: A Propensity-Matched Analysis
Patient group
1 Year
survival
%
5 year
survival
%
Pneumonia
n=32 83 62
p=0.03 Matched control
n=64 98 81
Rest of cohort
n=2628 98 91
Surgery n(%)
CABG 1162 (42)
Valve repair 884 (32)
Valve repair + CABG 487 (18)
Other 217 (8)
Type of surgery n(%)
Scheduled 2523 (92)
Unscheduled 227 (8)
Risk of long-term mortality
associated with pneumonia
HR 3.96 (95% CI, 1.41-11.14)
Ibanez J, J Intensive Care Med
![Page 36: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/36.jpg)
From Sepsis to Chronic Critical Illness Mira J.C., Crit Care Med 2017
![Page 37: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/37.jpg)
Marchioni A, Eur J Clin Invest 2015
![Page 38: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/38.jpg)
Burden of Six Healthcare-Associated Infections on European Population Health:
- Years of life lost due to premature mortality (YLL) - Years lived with disability (YLD)
Cassini A, PLoS Med 2016
![Page 39: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/39.jpg)
Incidence of microbiologically diagnosed
pneumonias in 34 Austrian ICUs
Burgmann H, Int Care Med 2010
Median 10.1 (5.7-18.2) per 100 pts
![Page 40: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/40.jpg)
Bacterial cross transmissions
and nosocomial infection rates
4.6 cross transmissions/1000 patient days
Kola A
Crit Care Med
2010
![Page 41: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/41.jpg)
Device-associated infection rates ranged
from 0.9 to 9.6 per 1000 device-days
• German KISS (2005-2009
• 800 Hospitals, 586 ICUs
Geffers C, Dtsch Ärzteblatt 2011
![Page 42: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/42.jpg)
A. Valentin 10/2004
Risk as probability of an
unfavourable outcome
Intrinsic Risk
• Premorbidity & Age
• Current Diagnosis
• Severity of Illness
Extrinsic Risk
• Treatment decisions
• Process of care
• Infection Prevention
• ………………
![Page 43: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/43.jpg)
Hugonnet S, Crit Care Med 2007
The effect of workload on infection risk
in critically ill patients
The daily proportion
of infected pts
is correlated with
nurse to patient ratio
of days 2-4 prior
![Page 44: Prognostische Implikationen Nosokomialer Infektionen · a secondary analysis of the European (EU)-VAP/ CAP database Koulenti D, Eur J Clin Microbiol Infect Dis 2015 . ICU acquired](https://reader035.vdocuments.site/reader035/viewer/2022081409/60848c4f0009864cf11b5b84/html5/thumbnails/44.jpg)
Noso-komiale
Infektion
• Mortalitätsrisiko (ICU, KH) • Risiko Chronic Critical Illness • Langzeitprognose?