Ocular diseases and their association with mortality in intensive care unit patients: a retrospective cohort study from the MIMIC-IV database

Introduction Ocular diseases, though common in intensive care unit (ICU) patients, are often overlooked due to prioritisation of organ failure management. Their comorbidities, clinical features and prognostic effects require large-scale investigation. Measurements and main results This study used data from the Medical Information Mart for Intensive Care IV database (V. 2.2). Random forest models were used to determine the importance of factors for 1-year mortality and in-hospital mortality. Multivariate logistic regression models were employed to identify the independent risk factors associated with in-hospital mortality in acute ocular disease subgroups. A total of 40 149 patients were identified in this study as eligible for the final analysis. The median age was 67.1 years, 22 734 (56.6%) were male and 3920 (9.8%) had ocular disease. 401 had acute ocular diseases, 2563 had chronic ocular diseases, 948 had neurological ocular diseases and 26 suffered from traumatic ocular diseases. Patients with acute ocular diseases had significantly higher proportions of acute kidney injury (76.8%, p=0.024), intensive mechanical ventilation (51.9%, p=0.015), norepinephrine (23.4%, p=0.008), neuro block (5.0%, p=0.001), sedation (59.6%, p=0.004) and sepsis (59.6%, p<0.001) than those without. There were different trends among cohorts with or without chronic ocular disease. Patients with chronic ocular diseases had a significantly higher 1-year mortality after ICU admission than those without (log-rank p=0.0001). Acute non-traumatic haemorrhagic ocular disease was independently associated with increased in-hospital mortality (OR 2.69, 95% CI 1.24 to 5.84) among ICU patients with acute ocular complications. Conclusions ICU patients with chronic ocular diseases exhibited higher long-term mortality. Acute ocular diseases may indicate a higher severity of illness in critically ill patients. Within the subgroup of acute ocular diseases, acute non-traumatic haemorrhagic ocular diseases were independently associated with increased in-hospital mortality. Limitations include retrospective under-ascertainment of asymptomatic cases and inability to distinguish aetiologies.