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Introduction <p>Intensive care units (ICUs) represent high-risk environments for adverse events (AEs). Preventing these events requires a solid understanding of their epidemiology based on standardized and validated methodologies. The aim of this study was to quantify AEs using the established Harvard Medical Practice Study (HMPS) methodology, identify associated factors, and analyze their prognostic impact on critically ill patients.</p> Materials and methods <p>A multicenter observational study with a cross-sectional design was conducted in 26 hospitals across the Community of Madrid on a single, specified day in May 2019. Following the HMPS methodology and using its standardized instruments, clinical records were reviewed in two phases: (1) an AE screening phase and (2) a confirmation and characterization phase for cases with positive screenings. A multivariate logistic regression model was developed to identify variables associated with the presence of AEs, and the association between AEs and in-hospital mortality was assessed using an explanatory model adjusted for potential confounders.</p> Results <p>A total of 458 patients were included, of whom 125 (27.3%; 95% CI: 23.4 to 31.6) had ≥1 AE. The following antecedents were associated with the presence of AEs: pressure ulcer (PU), hypoalbuminemia, mechanical ventilation, central venous catheter, surgical intervention and sensory deficit. Among the AEs found, 44.6% were health care-associated infections (HAIs). In-hospital mortality among patients with AEs was twice that observed in patients without AEs (OR: 2.15; 95% CI: 1.10–4.25).</p> Conclusions <p>The presence of AEs was associated with a two-fold higher risk of in-hospital mortality. Among the identified AEs, HAIs were the most frequent and had the highest mortality. Designing and implementing bundles of measures adapted to the individual risk of presenting AEs in the ICU emerges as the next step in the development of strategies to reduce the prevalence of AEs.</p>

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Adverse events as key risk factors for in-hospital mortality in intensive care units

  • 期刊论文

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  • 发表日期：

    2026年3月7日

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  • M. Roncal-Redín,
  • D. San Jose-Saras,
  • C. Díaz-Agero Pérez,
  • J. Vicente-Guijarro,
  • P. Moreno-Nunez,
  • B. Peñalver-Argüeso,
  • J. M. Aranaz-Andres,
  • José Lorenzo Valencia Martín,
  • Asunción Colomer Rosas,
  • Inmaculada Mediavilla Herrera,
  • Mª José Esteban Niveiro,
  • Nieves López Fresneña,
  • Alberto Pardo-Hernández,
  • Pedro Ruiz Lopez,
  • Isabel Carrasco Gonzalez,
  • Cristina Navarro Royo,
  • Carmen Albéniz Lizarraga,
  • Yuri Fabiola Villan Villan,
  • Ana Isabel Alguacil Pau,
  • Alicia Díaz Redondo,
  • Rosa Plá Mestre,
  • Dolores Martín Ríos,
  • Angels Figuerola Tejerina,
  • Carlos Aibar Remón,
  • José Joaquín Mira Solves,
  • Idelfonso González Solana,
  • Montserrat Salcero Guijarro,
  • Delia Fernández Redondo,
  • Esteban del Pozo García,
  • Cornelia Bischofberger Valdés,
  • Libertad Martín Prieto,
  • Marta Grande Arnesto,
  • Beatriz Nieto Pereda,
  • Ana Herranz Alonso,
  • Alicia Díaz Redondo,
  • Laura Rubio Cirilo,
  • Rafael Martos Martínez,
  • María Teresa Ledo Varela,
  • María Vicenta García Rosado,
  • Jesús Minaya Saíz,
  • María Jesús Labrador Domínguez,
  • María José Pita López,
  • Elia Mayoral Peccis,
  • Marco Antonio Espinel Ruíz,
  • Ana Polo Parada,
  • Emely García Carrasco,
  • Carlos Aranda Cosgaya,
  • Carmen Gutiérrez Bezón,
  • María de Sebastián Rueda,
  • Miguel Ruíz Álvarez,
  • Mercedes Vinuesa Sebastián,
  • María Dolors Montserrat Capella,
  • Carolina Ruíz Entrecanales,
  • Sonia de Miguel Fernández,
  • María Pilar González Sánchez,
  • Felisa Jaén Herreros,
  • María José Durá Jiménez,
  • Carmen de Burgos Lunar,
  • Anabel Alguacil Pau,
  • María Ángel Valcárcel de la Iglesia,
  • Laura Moratilla Monzó,
  • Mercedes Ortiz Otero,
  • Margarita Mosquera González,
  • Susana Lorenzo Martínez,
  • María Dolores Martín Ríos,
  • Carolina Lucas Molina,
  • María Teresa Sayalero Martín,
  • María Dolores Calles Gato,
  • Juan José Granizo Martínez,
  • Juan Vega Barea,
  • Eva Jiménez González de uitrago,
  • Inés Fernández Jiménez,
  • Cristina García Fernández,
  • Inmaculada López Carrillo,
  • Ana Robustillo Rodela,
  • Elena Ramírez García,
  • Romina Sánchez Gómez,
  • Nieves Franco Garrobo,
  • Nieves Plana Farrá,
  • Marta Macías Maroto,
  • Marta Soler Vigil,
  • Gonzalo de las Casas Cámara,
  • Nuria Gálvez Carranza,
  • Ana Belén Jiménez Muñoz,
  • Belén Martínez Mondéjar,
  • Beatriz Isidoro Fernández,
  • Lourdes Sainz de los Terreros oler,
  • Carolina del Valle Giráldez García,
  • Ruth González Ferrer,
  • Guillermo Ordóñez León,
  • Miguel Miró Murillo,
  • Rosalía Hernández Holgado,
  • Pilar Paloma Blanco Hernández,
  • José Manuel Carrascosa Bernaldez,
  • Sonia Fraile Gil,
  • Beatriz Fidalgo Hermida

摘要

Introduction

Intensive care units (ICUs) represent high-risk environments for adverse events (AEs). Preventing these events requires a solid understanding of their epidemiology based on standardized and validated methodologies. The aim of this study was to quantify AEs using the established Harvard Medical Practice Study (HMPS) methodology, identify associated factors, and analyze their prognostic impact on critically ill patients.

Materials and methods

A multicenter observational study with a cross-sectional design was conducted in 26 hospitals across the Community of Madrid on a single, specified day in May 2019. Following the HMPS methodology and using its standardized instruments, clinical records were reviewed in two phases: (1) an AE screening phase and (2) a confirmation and characterization phase for cases with positive screenings. A multivariate logistic regression model was developed to identify variables associated with the presence of AEs, and the association between AEs and in-hospital mortality was assessed using an explanatory model adjusted for potential confounders.

Results

A total of 458 patients were included, of whom 125 (27.3%; 95% CI: 23.4 to 31.6) had ≥1 AE. The following antecedents were associated with the presence of AEs: pressure ulcer (PU), hypoalbuminemia, mechanical ventilation, central venous catheter, surgical intervention and sensory deficit. Among the AEs found, 44.6% were health care-associated infections (HAIs). In-hospital mortality among patients with AEs was twice that observed in patients without AEs (OR: 2.15; 95% CI: 1.10–4.25).

Conclusions

The presence of AEs was associated with a two-fold higher risk of in-hospital mortality. Among the identified AEs, HAIs were the most frequent and had the highest mortality. Designing and implementing bundles of measures adapted to the individual risk of presenting AEs in the ICU emerges as the next step in the development of strategies to reduce the prevalence of AEs.