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Effect of do-not-resuscitate orders on patients with sepsis in the medical intensive care unit: a retrospective, observational and propensity score-matched study in a tertiary referral hospital in Taiwan
  1. Ya-Chun Chang1,
  2. Ying-Tang Fang1,
  3. Hung-Cheng Chen1,
  4. Chiung-Yu Lin1,
  5. Yu-Ping Chang1,
  6. Yu-Mu Chen1,
  7. Chi-Han Huang1,
  8. Kuo-Tung Huang1,
  9. Huang-Chih Chang1,
  10. Mao-Chang Su1,2,3,
  11. Yi-Hsi Wang1,3,
  12. Chin-Chou Wang1,2,3,
  13. Meng-Chih Lin1,3,
  14. Wen-Feng Fang1,2,3
  1. 1Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
  2. 2Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
  3. 3Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
  1. Correspondence to Dr Wen-Feng Fang; fangwf{at}; wenfengfang{at}


Objective The aim of this study was to determine whether do-not-resuscitate (DNR) orders affect outcomes in patients with sepsis admitted to intensive care unit (ICU).

Design This is a retrospective observational study.

Participants We enrolled 796 consecutive adult intensive care patients at Kaohsiung Chang Gung Memorial Hospital, a 2700-bed tertiary teaching hospital in southern Taiwan. A total of 717 patients were included.

Main measures Clinical factors such as age, gender and other clinical factors possibly related to DNR orders and hospital mortality were recorded.

Key results There were 455 patients in the group without DNR orders and 262 patients in the group with DNR orders. Within the DNR group, patients were further grouped into early (orders signed on intensive care day 1, n=126) and late (signed after day 1, n=136). Patients in the DNR group were older and more likely to have malignancy than the group without DNR orders. Mortality at days 7, 14 and 28, as well as intensive care and hospital mortality, were all worse in these patients even after propensity-score matching. There were higher Charlson Comorbidity Index in the emergency room, but better outcomes in those with early-DNR orders compared with late-DNR orders.

Conclusions DNR orders may predict worse outcomes for patients with sepsis admitted to medical ICUs. The survival rate in the early-DNR order group was not inferior to the late-DNR order group.

  • do-not-resuscitate orders
  • sepsis
  • intensive care unit

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  • Contributors Y-CC, Y-TF and W-FF were involved in study design and literature review. Y-CC, H-CC, C-YL, Y-PC, Y-MC, C-HH, K-TH and H-CC contributed to data collection. Y-CC, Y-MC, M-CS, Y-HW, C-CW and M-CL contributed to statistical analysis. Y-CC, Y-TF, Y-MC and K-TH drafted the article. Y-CC, Y-HW, C-CW, M-CL and W-FF critically revised the manuscript. All authors read and approved the final manuscript. Moreover, all authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of the work are appropriately investigated and resolved.

  • Funding The work is supported in part by grants from the Chang Gung Medical Foundation/Chang Gung Memorial Hospital (CMRPG8B1063, CMRPG8F0821, CMRPG8F1331 and CMRPG8H1171 to W-FF; CMRPG8B1073 to Y-HW and CMRPG8B1083 to C-CW).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

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