Mayr Viktoria D, Dünser Martin W, Greil Veronika, Jochberger Stefan, Luckner Günter, Ulmer Hanno, Friesenecker Barbara E, Takala Jukka, Hasibeder Walter R
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
Crit Care. 2006;10(6):R154. doi: 10.1186/cc5086.
Whereas most studies focus on laboratory and clinical research, little is known about the causes of death and risk factors for death in critically ill patients.
Three thousand seven hundred patients admitted to an adult intensive care unit (ICU) were prospectively evaluated. Study endpoints were to evaluate causes of death and risk factors for death in the ICU, in the hospital after discharge from ICU, and within one year after ICU admission. Causes of death in the ICU were defined according to standard ICU practice, whereas deaths in the hospital and at one year were defined and grouped according to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) score. Stepwise logistic regression analyses were separately calculated to identify independent risk factors for death during the given time periods.
Acute, refractory multiple organ dysfunction syndrome was the most frequent cause of death in the ICU (47%), and central nervous system failure (relative risk [RR] 16.07, 95% confidence interval [CI] 8.3 to 31.4, p < 0.001) and cardiovascular failure (RR 11.83, 95% CI 5.2 to 27.1, p < 0.001) were the two most important risk factors for death in the ICU. Malignant tumour disease and exacerbation of chronic cardiovascular disease were the most frequent causes of death in the hospital (31.3% and 19.4%, respectively) and at one year (33.2% and 16.1%, respectively).
In this primarily surgical critically ill patient population, acute or chronic multiple organ dysfunction syndrome prevailed over single-organ failure or unexpected cardiac arrest as a cause of death in the ICU. Malignant tumour disease and chronic cardiovascular disease were the most important causes of death after ICU discharge.
尽管大多数研究聚焦于实验室和临床研究，但对于重症患者的死亡原因和死亡风险因素却知之甚少。
对3700例入住成人重症监护病房（ICU）的患者进行前瞻性评估。研究终点是评估ICU内、从ICU出院后在医院以及ICU入院后一年内的死亡原因和死亡风险因素。ICU内的死亡原因根据标准ICU实践进行定义，而医院内和一年后的死亡则根据ICD - 10（国际疾病和相关健康问题统计分类）评分进行定义和分组。分别进行逐步逻辑回归分析，以确定特定时间段内死亡的独立风险因素。
急性、难治性多器官功能障碍综合征是ICU中最常见的死亡原因（47%），中枢神经系统衰竭（相对风险[RR] 16.07，95%置信区间[CI] 8.3至31.4，p < 0.001）和心血管衰竭（RR 11.83，95% CI 5.2至27.1，p < 0.001）是ICU中两个最重要的死亡风险因素。恶性肿瘤疾病和慢性心血管疾病加重分别是医院内（分别为31.3%和19.4%）和一年后（分别为33.2%和16.1%）最常见的死亡原因。
在这个以手术为主的重症患者群体中，急性或慢性多器官功能障碍综合征作为ICU死亡原因比单器官衰竭或意外心脏骤停更为常见。恶性肿瘤疾病和慢性心血管疾病是ICU出院后最重要的死亡原因。
