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The following is a summary of “Beyond Infection: Mortality and End-of-Life Care Associated with Infectious Disease Consultation in an Academic Health System,” published in the June 2024 issue of Infectious Disease by Smith et al.
The prevalence of terminal or incurable infectious diseases (ID) is presenting a growing challenge for ID specialists.
Researchers conducted a retrospective study aiming to explore the evolving role of ID physicians in managing patients with terminal or untreatable infections.
They analyzed patients who received an ID consultation within a large academic health system (January 2014 and December 2023). The analysis included community medicine, general internal medicine, and transplant services consultations.
The result showed 60,820 inpatients with ID consultations across three categories: 17,235 in the community, 29,999 in general cases, and 13,586 in transplant cases involving 37,848 unique patients. A notable increase of 94% in consultation numbers was observed, with rates rising from 5.0 to 9.9 consultations per 100 inpatients (P<0.001). Overall, 7.5% of patients who received an ID consult died during hospital admission, and 2.6% were discharged to hospice care. In-hospital mortality rates varied significantly by ID consult type, with rates of 5.2% for community, 7.8% for general, and 10.7% for transplant patients with ID, respectively (P<0.001). Six-month mortality rates were 9% for all non-obstetric admissions and notably higher at 19% for the community, 20.9% for general, and 22.3% for transplant of patients with ID, respectively. A total of 2,866(7.6%) of patients who received ID consultation also received palliative care during the hospitalization, with the ID consultation preceding palliative care in 69.5% of cases. Additionally, 16.3% of patients had a do-not-resuscitate order during their hospital stay, with 12.2% initiated on the same day as the ID consult.
Investigators concluded that patients receiving ID consultation exhibited heightened complexity and higher mortality rates shortly after consultation, highlighting the pivotal role of ID clinicians in end-of-life care (EOL) considerations.
Source: academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae325/7692210
