González-Castro A, Suberviola B, Llorca J, González-Mansilla C, Ortiz-Melón F, Miñambres E
Service of Intensive Care, Lung Transplant Unit, Hospital Universitario Marques de Valdecilla, Santander, Spain.
Transplant Proc. 2007 Sep;39(7):2420-1. doi: 10.1016/j.transproceed.2007.06.058.
To identify outcome predictors and prognostic factors for survival among lung transplant recipients on readmission to the intensive care unit (ICU).
This was a retrospective study of all lung transplant recipients during a 10-year period from 1997 to 2006. Data collection included age, gender, reason, and type of lung transplantation. Variables specific to individual ICU admissions included admission diagnosis, length of stay, duration of mechanical ventilation, interval from transplantation, Acute Physiology and Chronic Health Evaluation (APACHE) II score on ICU admission, and the identification of systemic organ dysfunction. We used Student t test (or where appropriate, its nonparametric equivalent) or the chi(2) test for comparisons among the patients who died and those who survived their ICU readmissions.
Among 144 lung transplant patients 28 were later readmitted to the ICU after at least 1 week. The admission diagnosis was sepsis in 20 cases (71.4%). Seventeen patients died during their ICU stay (60.7%). A higher APACHE II score (P = .008), the presence of three or more dysfunctional organs upon readmission (P = .016), and the need for mechanical ventilation (P = .022) were risk factors for mortality. The mortality risk was also higher among the group with a longer delay to ICU readmission (P = .003).
Readmission to the ICU, which is common among lung transplant recipients, was associated with a high mortality. Sepsis was the main cause of ICU readmission and the most frequent cause of death. APACHE II score, need for mechanical ventilation, number of dysfunctional organs, and delay in ICU readmission were important prognostic factors.
确定再次入住重症监护病房（ICU）的肺移植受者生存的结局预测因素和预后因素。
这是一项对1997年至2006年10年间所有肺移植受者的回顾性研究。数据收集包括年龄、性别、肺移植的原因和类型。特定于每次ICU入院的变量包括入院诊断、住院时间、机械通气时间、移植后的间隔时间、ICU入院时的急性生理与慢性健康状况评估（APACHE）II评分以及全身器官功能障碍的识别。我们使用Student t检验（或在适当情况下使用其非参数等效检验）或卡方检验对ICU再入院后死亡和存活的患者进行比较。
144例肺移植患者中，28例在至少1周后再次入住ICU。入院诊断为脓毒症的有20例（71.4%）。17例患者在ICU住院期间死亡（60.7%）。较高的APACHE II评分（P = 0.008）、再入院时存在三个或更多功能障碍器官（P = 0.016）以及需要机械通气（P = 0.022）是死亡的危险因素。ICU再入院延迟时间较长的组中死亡风险也较高（P = 0.003）。
再次入住ICU在肺移植受者中很常见，且与高死亡率相关。脓毒症是ICU再入院的主要原因和最常见的死亡原因。APACHE II评分、机械通气需求、功能障碍器官数量以及ICU再入院延迟是重要的预后因素。
