Data supplement

Table E1Cumulative probability (expressed from 0 to 1 and 95% confidence interval) for the first DFLST at day 1, day 3 and day 7 of ICU stay

Estimator [CI 95%] / Day1 / Day3 / Day7
No escalation of treatment / 0.079 [0.074 ; 0.084] / 0.095 [0.089 ; 0.100] / 0.109 [0.103 ; 0.115]
withholding / 0.041 [0.037 ; 0.045] / 0.058 [0.054 ; 0.063] / 0.076 [0.071 ; 0.082]
withdrawal / 0.014 [0.012 ; 0.07] / 0.023 [0.020 ; 0.026] / 0.034 [0.031 ; 0.038]

Table E2 Multivariable analysison ICU mortality

Unadjusted model / Adjusted model
Parameter / HR / CI 95% / P value / HR / CI 95% / P value
No DFLST / 1 / - / - / 1 / - / -
No escalation of treatment / 1.67 / (1.32-2.12) / <0.0001 / 0.84 / (0.66-1.08) / 0.17
withholding / 12.99 / (11.17-15.11) / <0.0001 / 5.79 / (4.76-7.04) / <0.0001
withdrawal / 36.86 / (30.30-44.85) / <0.0001 / 20.92 / (16.06-27.26) / <0.0001
Variables collected at admission*
Patient status
Medical / - / - / - / 0.99 / (0.73-1.352) / 0.97
Unscheduled surgery / - / - / - / 0.77 / (0.55-1.07) / 0.12
Scheduled surgery / - / - / - / 1 / - / -
Main symptom
MOF or shock / - / - / - / 0.73 / (0.40-1.31) / 0.29
Acute respiratory distress / - / - / - / 0.65 / (0.36-1.17) / 0.15
AE-COPD / - / - / - / 0.83 / (0.43-1.61)
0.280 / 0.58
Acute renal failure / - / - / - / 0.36 / (0.18-0.71) / 0.003
Coma / - / - / - / 0.81 / (0.44-1.47) / 0.48
Monitoring or scheduled surgery / - / - / - / 0.62 / (0.34-1.13) / 0.12
Major trauma / - / - / - / 1 / - / -
Main diagnosis
Drug intoxication / - / - / - / 0.27 / (0.14-0.52) / 0.0001
Severity of illness
SAPSII score (per point) / - / - / - / 1.04 / (1.04-1.05) / <0.0001
Time dependent covariate*
SOFA score (per point)** / - / - / - / 1.14 / (1.12-1.16) / <0.0001

DFLSTDecision to forgo life-sustaining treatment,MOF Multiple organ Failure,AE-COPDAcute Exacerbation of Chronic Obstructive Pulmonary Disease,SAPS IISimplified Acute Physiology Score (SAPS) version II,SOFASequential Organ Failure Assessment,HRHazard Ratio,CI 95%Confidence interval 95%

*: variables for adjustment; **: SOFA of day before decision making

Other prognostic variables tested and not kept in the final model were: transfer; mechanical ventilation at the admission; sunday as day of DFLST procedure; age; more than one chronic disease; dementia or malnutrition.

Fig E1 Cumulative probability curve for the first DFLST

Fig E2 Impact of the decision to forgo life-sustaining treatment on mortality

DFLSTDecision to forgo life-sustaining treatment