Predictors of mortality in the intensive care unit for adult patients admitted on mechanical ventilation: admission profile

Authors

DOI:

https://doi.org/10.31686/ijier.vol9.iss5.3078

Keywords:

Nursing workload, risk factor, Nursing Activities Score, blood urea, chronic obstructive pulmonary disease, thyrodopathies

Abstract

Evaluating risk factors for mortality in local populations such as adult patients admitted on mechanical ventilation in intensive care units (ICU) may provide support for the management and improvement of outcomes in these units. The inclusion of the workload of professionals in these models has offered a different view of predictors. The aim of this study was to evaluate whether Nursing workload assessed by the Nursing Activities Score (NAS), predictors of mortality (APACHEII and SAPS3) and some additional admission variables for patients admitted on mechanical ventilation in an ICU are predictors of death. We evaluated 194 patients who remained on mechanical ventilation for 48 hours before or after admission in one ICU, in a university hospital of high complexity. The clinical and socio-demographic profile, the NAS of admission and some admission variables were evaluated. The outcome discharge or death in the ICU was evaluated for all patients, and from simple or multiple logistic regression models, risk or protective factors for death in the ICU were obtained. Individually, only SAPS3 was significant for prediction of death (OR = 1.03; CI95%: 1.01; 1.05), while the APACHEII and the NAS of admission was not able to predict ICU mortality. In the multiple model, the only risk factors for ICU mortality were the presence of chronic obstructive pulmonary disease (OR = 8.82; CI95%: 1.82; 42.70), having thyroid diseases (OR = 5.98; CI95%: 1.15; 31.22) and the increase in the level of urea in the blood (OR = 1.01; CI95%: 1,002; 1.02). The admission variables of this population were more effective in predicting ICU mortality than the predictors of mortality evaluated here.

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Author Biographies

Clesnan Mendes-Rodrigues, Federal University of Uberlândia

Statistician, Biologist and Nurse. Nursing, Medicine Faculty

Fabiola Alves Gomes, Federal University of Uberlândia

Nurse. Nursing, Medicine Faculty

Denise Von Dolinger de Brito Röder, Federal University of Uberlândia

Biologist. Institute of Biomedical Sciences

Thúlio Marquez Cunha, Federal University of Uberlândia

Physician. Medicine Faculty

Guilherme Silva Mendonça, Federal University of Uberlândia

Nurse, Educator. Clinical Hospital of Uberlândia

Karine Santana de Azevedo Zago, Federal University of Uberlândia

Nurse. Nursing, Medicine Faculty

Quintiliano Siqueira Schroden Nomelini, Universidade Federal do Acre

Mathematician. Statistics, Mathematics Faculty

References

AGÊNCIA NACIONAL DE VIGILÂNCIA SANITÁRIA (ANVISA - BRASIL). Resolução da Diretoria Colegiada nº 7, de 24 de fev. de 2010. Dispõe sobre os requisitos mínimos para funcionamento de unidades de terapia intensiva e dá outras providências. Diário Oficial da União 25 fev. 2010. Available at: http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2010/res0007_24_02_2010.html Access in: 01 Nov. de 2020.

ANTUNES, A.V.; LOURENÇO, A.M.; FRANÇA, C.E.; MENDES-RODRIGUES, C. Evaluation of Nursing notes before and after a training activity in a university hospital. Revista Prevenção de Infecção e Saúde, Piauí, v. 4, n. 7208, 2018. http://dx.doi.org/10.26694/repis.v4i0.7208

ARÊA LEÃO, F.G.; MARQUES, I.D.B.; MELLO, P.M.V.C. Validação do índice prognóstico SAPS 3 em pacientes internados na UTI de um hospital terciário de Teresina (PI). Jornal de Ciências da Saúde do Hospital Universitário da Universidade Federal do Piauí, Teresina, v. 1, n. 3, p. 9-19, Sept. 2018. https://doi.org/10.26694/2595-0290.2018139-197207

BRASIL. Ministério da Saúde. Conselho Nacional de Saúde. Resolução n. 466, de 12 de dezembro de 2012. Aprova diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, 12 dez. 2012. Available at: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html Acesso em: 01 Nov. de 2020.

BRASIL. Ministério da Saúde. Portaria nº 3.432 de 12 de agosto de 1998. Estabelece critérios de classificação entre as diferentes Unidades de Tratamento Intensivo - UTI. Diário Oficial da União, 12 Ago. 1998. Available at: http://bvsms.saude.gov.br/bvs/saudelegis/gm/1998/prt3432_12_08_1998.html Acess in: 01 Nov. de 2020.

BRUYNEEL A., TACK, J.; DROQUET, M.; MAES,J.; WITTEBOLE, X.; MIRANDA, D. R.; PIERDOMENICO, L.D. Measuring the Nursing workload in intensive care with the Nursing Activities Score (NAS): A prospective study in 16 hospitals in Belgium. Journal of Critical Care, Orlando, v. 54, p. 205-211, Dec. 2019. https://doi.org/10.1016/j.jcrc.2019.08.032

CAMARGO L.F.A.; DE MARCO F.V.; BARBAS C.S.V.; HOELZ C.; BUENO M.A.S.; RODRIGUES JR. M.; AMADO V.M.; CASERTA R.; MARTINO, M.D.V.; PSTERNAK J.; KNOBEL E. Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates. Critical Care, New York, v. 8, n. 6, p. 422-430, Oct. 2004. https://doi.org/10.1186/cc2965

CASTELLAN, C.; SLUGA, S.; SPINA, E.; SANSON, G: Nursing diagnoses, outcomes and interventions as measures of patient complexity and nursing care requirement in intensive care unit. Journal of Advanced Nursing, Oxford, v. 72, n. 6, p. 1273–1286, Jun. 2016. https://dx.doi.org/2016. 10.1111/jan.12913

COSTA, M.C.M. Carga de trabalho de enfermagem pelo Nursing Activities Score (NAS) e preditores de mortalidade de pacientes em uma unidade de terapia intensiva neurológica. 2020. 60 p. Residency Completion Work (Residency in Health Sciences) – Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, 2020. Available at: https://repositorio.ufu.br/handle/123456789/28787 Access in: 01 Nov. de 2020.

FISHER, R.A. On the interpretation of χ2 from contingency tables, and the calculation of p. Journal of the Royal Statistical Society. v. 85 n. 1, p. 87–94, 1922. https://doi.org/10.2307/2340521

FISHER, R.A. The conditions under which χ2 measures the discrepancy between observation and hypothesis. Journal of the Royal Statistical Society, v. 87, n. 3, p. 442–450, 1924.

GALL, J.R.; LEMESHOW, S.; SAULNIER, F.. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. Journal of the American Medical Association, Chicago, v. 270, n. 24, p. 2957-2963, 1993. https://doi.org/10.1001/jama.270.24.2957

GALL, J.R.; LOIRAT, .P; ALPEROVITCH, A.; GLASER, P.; GRANTHIL, C.; MATHIEU, D.; MERCIER, P.; THOMAS, R.; VILLERS, D. A simplified acute physiology score for ICU patients. Critical Care Medicine, Mount Prospect, v. 12, n. 11, p. 975–977, 1984. https://doi.org/10.1097/00003246-198411000-00012

GOMES, F.A. Avaliação do impacto da carga de trabalho da equipe de enfermagem de unidade de terapia intensiva adulto sobre a incidência de pneumonia associada à ventilação mecânica. 2018. 57 p. il. Thesis (PhD in Health Sciences) - Universidade Federal de Uberlândia. http://dx.doi.org/10.14393/ufu.te.2018.62

GOMES, F.A.; RÖDER, D.V.D.B.; CUNHA, T.M.; CARDOSO FILHO, G.M.; MENDES-RODRIGUES, C.; MENDONÇA, G.S.; PEREIRA, E.B.S. Adherence to ventilator-associated pneumonia prevention measures in intensive care. Revista Prevenção de Infecção e Saúde, Teresina, v. 6, 9165, 2020. https://doi.org/10.26694/repis.v6i0.9165

GOMES, F.A.; RÖDER, D.V.D.B.; CUNHA, T.M.; FELICE, R.O.; MENDONÇA, G.S.; MENDES-RODRIGUES, C. The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit. Journal of Nursing Education and Practice, Hawthorne, v. 9, n. 9, p. 104-114. Sept. 2019. https://doi.org/104-114. 10.5430/jnep.v9n9p104

GULINI, J.E.H.M.B; NASCIMENTO, E.R.P.; MORITZ, R.D.; VARGAS, M.A.O.; MATTE, D.L.; CABRAL, R.P. Predictors of death in an Intensive Care Unit: contribution to the palliative approach. Revista da Escola de Enfermagem USP, São Paulo, v. 52, e03342, 2018. https://dx.doi.org/10.1590/S1980-220X2017023203342

GUTCH M.; KUMAR S.; GUPTA K.K. prognostic value of thyroid profile in critical care condition. Indian Journal of Endocrinology and Metabolism, Mumbai, v. 22, n. 3 p. 387-391, May-Jun 2018. https://doi.org/10.4103/ijem.IJEM_20_18

HAINES, R.W.; FOWLER, A.J.; KIRWAN, C.J.; PROWLE, J.R. The incidence and associations of acute kidney injury in trauma patients admitted to critical care: A systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery; v. 86, n. 1, p. 141-147, Jan 2019. https://doi.org/10.1097/TA.0000000000002085

HETTMANSPERGER, T.P.; SHEATHER, S.J. Confidence Interval Based on Interpolated Order Statistics. Statistical Probability Letters, v. 4, p. 75-79. 1986 https://doi.org/10.1016/0167-7152(86)90021-0

HEYARD, R.; TIMSIT, J.F.; HELD, L.; COMBACTE-MAGNET CONSORTIUM.. Validation of discrete time‐to‐event prediction models in the presence of competing risks. Biometrical Journal, Weinheim, v. 62, n. 3, p. 643-657, 2020, https://dx.doi.org/10.1002/bimj.201800293

HISSA, P.N.G.; HISSA, M.R.N.; ARAÚJO, P.S.R. Comparative analysis between two scores in predicting mortality in intensive care unit. Revista da Sociedade Brasileira de Clínica Médica, São Paulo, v. 11, n. 1, p. 21-26, Jan.-Mar. 2013.

HOSMER, D.; LEMESHOW, S. Applied logistic regression. New York: John Wiley & Sons, 1989.

HUGONNET, S.; UÇKAY, I.; PITTET, D. Staffing level: A determinant of late-onset ventilator-associated pneumonia. Critical Care, London, v. 11. R80. https://dx.doi.org/200710.1186/cc5974

INGHAMMAR, M.; SUNDEN-CULLBERG, J. Prognostic significance of body temperature in the emergency department vs the ICU in Patients with severe sepsis or septic shock: A nationwide cohort study. PLOS ONE v. 15, n. 12, e0243990, 2020. https://doi.org/10.1371/journal.pone.0243990

JANSSON, M.M.; SYRJÄLÄ, H.P.; ALA-KOKKO, T.I. Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality: A prospective, single-center cohort study. Journal of Hospital Infection, New York, v. 101, n. 3, p. 257-263, Dec. 2019. https://dx.doi.org/10.1016/j.jhin.2018.12.001

KATO, T.; YAKU, H.; MORIMOTO, T.; INUZUKA, Y.; TAMAKI, Y.; YAMAMOTO. E.; YOSHIKAWA, Y.; KITAI, T.; TANIGUCHI R.; IGUCHI M.; KATO, M.; TAKAHASHI, M.; JINNAI, T.; TOMOYUKI IKEDA, T.; NAGAO, K.; KAWAI, T.; KOMASA, A.; RYUSUKE NISHIKAWA, R.; YUICHI KAWASE, Y.; TAKASHI MORINAGA, T.; KANAE SU, K.; KAWATO, M.; SEKO, Y.; INOKO, M.; TOYOFUKU, M.; FURUKAWA, Y.; NAKAGAWA, Y.;ANDO, K.; KADOTA, K.; SHIZUTA, S.; ONO, K.; SATO, Y.; KUWAHARA, K.; OZASA, N.; KIMURA T. Association with controlling nutritional Status (CONUT) Score and in-hospital mortality and infection in acute heart failure. Scientific Reports, London, v. 10, n. 1, p. 1-10, Feb. 2020. https://doi.org/10.1038/s41598-020-60404-9

KNAUS W.A.; DRAPER E.A.; WAGNER D.P.; ZIMMERMAN J.E. APACHE II: a severity of disease classification system. Critical Care Medicine, Mount Prospect, v. 13, n. 10, p. 818 – 829, Oct. 1985.

KÜNG, E.; WALDHÖR, T; RITTENSCHOBER-BÖHM, J.; BERGER, A.; WISGRILL, L. Increased nurse workload is associated with bloodstream infections in very low birth weight infants. Scientific Reports. v. 9, n. 1, 6331, Apr. 2019. https://doi.org/10.1038/s41598-019-42685

LEEMIS, L.M.; TRIVEDI, K.S. A comparison of approximate interval estimators for the Bernoulli parameter. The American Statistician, Alexandria, v. 50, n. 1, p. 63-68, Feb.1996. https://doi.org/10.2307/2685046

LENTSCK, M.H.; OLIVEIRA, R.R.; CORONA, L.P.; MATHIAS, T.A.F. Risk factors for death of trauma patients admitted to an Intensive Care Uni. Revista Latino-Americana Enfermagem, Ribeirão Preto, v. 28, e3236, Feb. 2020 https://dx.doi.org/10.1590/1518-8345.3482.3236

LEVENE, H. Robust tests for the equality of variance. In: OLKIN, I (Ed.) Contributions to Probability and Statistics, Palo Alto, California: Stanford University Press, 1960, p. 278–292.

LOSS, S.H.; OLIVEIRA, ROSELAINE, P.; MACCARI, J.G.; SAVI, A.; BONIATTI, M.M.; HETZEL, M.P.; DALLEGRAVE, D.M.; BALZANO, P.C.; OLIVEIRA, E.S.; HÖHER, J.A.; TORELLY, A.P.; & TEIXEIRA, C. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Revista Brasileira de Terapia Intensiva, São Paulo, v. 27, n. 1, p. 26-35, Mar. 2015. https://dx.doi.org/10.5935/0103-507X.20150006

LUCENA, M.; SANTOS VELOSO, M.; XAVIER, G.; MORAES, F.; LUCENA, R.; MARKMAN-FILHO, B.; LIMA, S. Mortality prognostic factors associated with SAPS 3 and APACHE II in elderly patients admitted in intensive care unit. Medicina, São Paulo, v. 52. p. 277-285, 2019. http://dx.doi.org/10.11606/issn.2176-7262.v52i4.p277-285

MANN, H.B.; WHITNEY, D.R. On a test of whether one of two random variables is stochastically larger than the other. Annals of Mathematical Statistics, v. 18, n. 1, p. 50-60, 1947. https://dx.doi.org/doi:10.1214/aoms/1177730491

MARGADANT, C.; WORTEL, S.; HOOGENDOORN, M.; BOSMAN, R.; SPIJKSTRA, J.; BRINKMAN, S.; DE KEIZER, N.. The Nursing Activities Score per Nurse Ratio is associated with in-hospital mortality, whereas the Patients per Nurse Ratio is not. Critical Care Medicine. New York, Sept. 2019 https://dx.doi.org/10.1097/CCM.0000000000004005

MICHTALIK H.J.; YEH H.; PRONOVOST P.J.; BROTMAN D.J. Impact of attending physician workload on patient care: A survey of hospitalists. JAMA Internal Medicine, Chicago; v. 173, n. 5, p. 375–377, Mar. 2013. https://dx.doi.org/10.1001/jamainternmed.2013.1864

MIRANDA, D.R.; NAP, R.; DE RIJK, A.; SCHAUFELI, W.; IAPICHINO, G.; TISS WORKING GROUP. THERAPEUTIC INTERVENTION SCORING SYSTEM. Nursing Activities Score (NAS). Critical Care Medicine, New York, v. 32, n. 2, p. 375–382, 2003. https://dx.doi.org/10.1097/01.CCM.0000045567.78801.CC

MOHAMMED, A.E; SAIED, A.M.; SELIMA, W.Z.; IBRAHIM, W.S. impact of thyroid dysfunction in correlation to mortality rate of the critically ILL ICU patients (prospective observational study), QJM: An International Journal of Medicine, v. 113, n. 1, hcaa039.065, Mar. 2020. https://doi.org/10.1093/qjmed/hcaa039.065

MORENO, R.P.; NASSAR JR., A.P. Is APACHE II a useful tool for clinical research? Revista Brasileira de Terapia Intensiva, São Paulo, v. 29, n. 3, p. 264-267, Sept. 2017. https://doi.org/10.5935/0103-507x.20170046

MOTA, É.C.; OLIVEIRA, S.P.; SILVEIRA, B.R.M.; SILVA, P.L.N.; OLIVEIRA, A.C. Incidence of ventilator-associated pneumonia in intensive care unit. Medicine, Ribeirão Preto; v. 50, n. 1, p. 39-46, Feb. 2017. https://dx.doi.org/10.11606/issn.2176-7262.v50i1p39-46

NAGELKERKE, N.J.D. A note on a general definition of the coefficient of determination. Biometrika, Great Britain, v. 78, n. 3. p. 691-692, 1991. https://doi.org/10.1093/biomet/78.3.691

NEEDLEMAN, J.; LIU, J.; SHANG, J.; LARSON, E. L; STONE, P. W. Association of registered nurse and Nursing support staffing with inpatient hospital mortality. BMJ Quality & Safety, London, v. 29, n. 1, p. 10-18, Aug. 2020. https://dx.doi.org/10.1136/bmjqs-2018-009219

NOGUEIRA, L.S.; SANTOS, M.R.; MATALOUN, S.E.; MOOCK, M. Nursing Activities Score: Comparison among the Index APACHE II and the mortality in patients admitted in intensive care unit. Revista Brasileira de Terapia Intensiva, São Paulo, v. 19, n. 3, p. 327-330, Sept. 2007. https://dx.doi.org/10.1590/S0103-507X2007000300010

NOGUEIRA, T.D.A.; MENEGUETI, M.G.; PERDONÁ, G.D.S.C.; AUXILIADORA-MARTINS, M.; FUGULIN, F.M.T.; LAUS, A.M. Effect of nursing care hours on the outcomes of intensive care assistance. PLoS ONE, San Francisco, v. 12, n. 11, e0188241, 2017. https://doi.org/10.1371/journal.pone.0188241

OLIVEIRA, H.P. Modelo preditivo de óbito em pacientes vítimas de trauma admitidos em Unidade de Terapia Intensiva. 2020. 57 p. il. Thesis (PhD in Anesthesiology) - Faculdade de Medicina, University of São Paulo, São Paulo, 2020. https://dx.doi.org/10.11606/T.5.2020.tde-28102020-165038

OLIVEIRA, A.B.F.; DIAS, O.M.; MELLO, M.M.; ARAÚJO, S.; DRAGOSAVAC, D; NUCCI, A.; FALCÃO, A.L.E. Factors associated with increased mortality and prolonged length of stay in an adult intensive care unit. Revista Brasileira de Terapia Intensiva, São Paulo, v. 22, n. 3, p. 250-256, Sept. 2010. https://dx.doi.org/10.1590/S0103-507X2010000300006

OLIVEIRA, A.B.F.; DIAS, O.M.; MELLO, M.M.; ARAÚJO, S.; DRAGOSAVAC, D.; NUCCI, A.; FALCÃO, A.L.E. Factors associated with increased mortality and prolonged length of stay in an adult intensive care unit. Revista Brasileira de Terapia Intensiva, São Paulo, v. 22, n. 3, p. 250-256, Sept. 2010. https://doi.org/10.1590/S0103-507X2010000300006

PEARSON, K. On the criterion that a given system of deviations from the probable in the case of a correlated system of variables is such that it can be reasonably supposed to have arisen from random sampling. Philosophical Magazine. Series 5. v. 50 n.302, p. 157–175, 1900. http://dx.doi.org/10.1080/14786440009463897

PERES L.A.B.; WANDEUR V.; MATSUO T. Predictors of acute kidney injury and mortality in an Intensive Care Unit. Brazilian Journal of Nephrology, São Paulo, v. 37, n. 1, p. 38-46, Mar. 2015. http://dx.doi.org/10.5935/0101-2800.20150007

QUEIJO, A.F.; PADILHA, K.C. Nursing Activities Score (NAS): Cross-cultural adaptation and validation to Portuguese language. Revista da Escola de Enfermagem USP, São Paulo, v. 43, p. 1018–1025, 2009. https://dx.doi.org/10.1590/S0080-62342009000500004

R CORE TEAM (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.

RISSO, S.P.; NASCIMENTO, L.F.C. Risk factors for neonatal death in neonatal intensive care unit according to survival analysis. Revista Brasileira de Terapia Intensiva, São Paulo, v. 22, n. 1, p. 19-26, Mar. 2010. https://dx.doi.org/10.1590/S0103-507X2010000100005

ROCHA, L.A.; VILELA, C.A.; CEZÁRIO, R.C.; ALMEIDA, A.B.; GONTIJO FILHO, P. Ventilator-associated pneumonia in an adult clinical-surgical intensive care unit of Brazilian university hospital: incidence, risk factors, etiology, and antibiotic resistance. Brazilian Journal of Infectious Diseases, Salvador, v. 12, n. 1, p. 80-85, Feb. 2008 https://doi.org/10.1590/S1413-86702008000100017

SENTURK, E.; SENTURK, Z.; SEN, S.; TURE, M.; AVKAN, N. Mortality and associated factors in a thoracic surgery ICU. Jornal Brasileiro de Pneumologia, São Paulo, v. 37, n. 3, p. 367-374, May-Jun. 2011. https://dx.doi.org/10.1590/S1806-37132011000300014

SHAPIRO, S.S.; WILK, M. B.. An analysis of variance test for normality (complete samples). Biometrika, Great Britain, v. 52, no. 3/4, p. 591–611, 1965. https://doi.org/10.2307/2333709

SILVA JUNIOR, J.M.; MALBOUISSON, L.M.S.; NUEVO, H.L.; BARBOSA, L.G.T.; MARUBAYASHI, L.Y.; TEIXEIRA, I.C.; NASSAR JUNIOR, A.P.; CARMONA, M.J.C., SILVA, I.F.; AULER JÚNIOR, J.O.C.; REZENDE, E. Applicability of the Simplified Acute Physiology Score (SAPS 3) in Brazilian Hospitals. Revista Brasileira de Anestesiologia, v. 60, n. 1, p. 20-31, 2010. https://doi.org/10.1590/S0034-70942010000100003

SOARES, M.; DONGELMANS, D.A. Why should we not use APACHEII for performance measurement and benchmarking? Revista Brasileira de Terapia Intensiva, São Paulo, v. 29, n. 3, p. 268-270, Sept. 2017. https://doi.org/10.5935/0103-507x.20170043

SOUZA, S.P.D.; MATOS, R.S.; BARROS, L.L.; ROCHA, P.N. Inverse association between serum creatinine and mortality in acute kidney injury. Brazilian Journal of Nephrology, v. 36, n. 4, p. 469-475, Dec. 2014. http://dx.doi.org/10.5935/0101-2800.20140067

SPEARMAN, C.: The proof and measurement of association between two things. The American Journal of Psychology, v. 15, n. 1, p. 72–101, Jan. 1904. https://doi.org/10.2307/1412159

STUDENT The probable error of a mean. Biometrika, v. 6, n. 1, p 1–25, Mar. 1908, https://doi.org/10.1093/biomet/6.1.1

XIE, M.; LI, N.; QIAO, H.; GUO, JF.; LI, S.L. Acute kidney injury diagnosed by elevated serum creatinine increases mortality in ICU patients following non-cardiac surgery. Zhonghua Yi Xue Za Zhi, v. 100, n. 42, p. 3285-3290, Nov. 2020. https://doi.org/10.3760/cma.j.cn112137-20200318-00824

YATES, F. Contingency table involving small numbers and the χ2 test. Supplement to the Journal of the Royal Statistical Society. v. 1 n. 2, p. 217–235. https://doi.org/1934doi:10.2307/2983604

WANG, F.; PAN, W.; WANG, H.; WANG, S.; PAN, S.; GE, J. Relationship between thyroid function and ICU mortality: A prospective observation study. Critical Care, London, v. 16, n. R11, 2012. https://doi.org/10.1186/cc11151

WORLD MEDICAL ASSOCIATION DECLARATION OF HELSINKI. Recommendations guiding physicians in biomedical research involving human subjects. The Journal of the American Medical Association, Chicago, v. 277, n.11, p. 925-926. Mar. 1997. https://doi.org/10.1001/jama.1997.03540350075038

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01-05-2021

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Mendes-Rodrigues, C., Gomes, F. A., Röder, D. V. D. de B., Cunha, T. M., Mendonça, G. S., Zago, K. S. de A., & Nomelini, Q. S. S. (2021). Predictors of mortality in the intensive care unit for adult patients admitted on mechanical ventilation: admission profile. International Journal for Innovation Education and Research, 9(5), 121–139. https://doi.org/10.31686/ijier.vol9.iss5.3078

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