Iapichino Gaetano, Morabito Alberto, Mistraletti Giovanni, Ferla Luca, Radrizzani Danilo, Reis Miranda Dinis
Istituto di Anestesiologia e Rianimazione, Università di Milano, Azienda Ospedaliera-Polo Universitario San Paolo, via A. Di Rudinì 8, 20142 Milan, Italy.
Intensive Care Med. 2003 Oct;29(10):1751-6. doi: 10.1007/s00134-003-1915-8. Epub 2003 Aug 16.
To assess the predictive ability of preillness and illness variables, impact of care, and discharge variables on the post-intensive care mortality.
5,805 patients treated with high intensity of care in 89 ICUs in 12 European countries (EURICUS-I study) surviving ICU stay.
Case-mix was split in training sample (logistic regression model for post-ICU mortality: discrimination assessed by area under ROC curve) and in testing sample. Time to death was studied by Cox regression model validated with bootstrap sampling on the unsplit case-mix.
There were 5,805 high-intensity patients discharged to ward and 423 who died in hospital. Significant odds ratios were observed for source of admission, medical/surgical unscheduled admission, each year age, each SAPSII point, each consecutive day in high-intensity treatment, and each NEMS point on the last ICU day. Time to death in ward was significantly shortened by different source of admission; age over 78 years, medical/unscheduled surgical admission; SAPSII score without age, comorbidity and type of admission over 16 points; more than 2 days in high-intensity treatment; all days spent in high treatment; respiratory, cardiovascular, and renal support at discharge; and last ICU day NEMS higher than 27 points
Worse outcome is associated with the physiological reserve before admission in the ICU, type of illness, intensity of care required, and the clinical stability and/or the grade of nursing dependence at discharge.
评估病前和疾病变量、护理影响及出院变量对重症监护后死亡率的预测能力。
在12个欧洲国家的89个重症监护病房接受高强度护理治疗的5805例患者（EURICUS - I研究），这些患者存活至重症监护病房住院结束。
病例组合分为训练样本（用于重症监护后死亡率的逻辑回归模型：通过ROC曲线下面积评估辨别力）和测试样本。通过在未拆分的病例组合上进行自助抽样验证的Cox回归模型研究死亡时间。
有5805例高强度护理患者出院至病房，423例在医院死亡。观察到入院来源、内科/外科非计划入院、每一岁年龄、每一个简化急性生理学评分II（SAPSII）点、高强度治疗的每一天、重症监护病房最后一天的每一个神经功能缺损评分（NEMS）点的显著比值比。不同的入院来源显著缩短了在病房的死亡时间；年龄超过78岁、内科/非计划外科入院；不考虑年龄、合并症和入院类型的SAPSII评分超过16分；高强度治疗超过2天；在高强度治疗的所有天数；出院时的呼吸、心血管和肾脏支持；以及重症监护病房最后一天NEMS高于27分。
较差的预后与入住重症监护病房前的生理储备、疾病类型、所需护理强度以及出院时的临床稳定性和/或护理依赖程度有关。
