Ho Kwok M, Lee Kok Y, Dobb Geoffrey J, Webb Steven A R
Department of Intensive Care, Royal Perth Hospital, 6000, Perth, WA, Australia.
Intensive Care Med. 2008 Mar;34(3):481-7. doi: 10.1007/s00134-007-0928-0. Epub 2007 Nov 9.
The objective was to assess the ability of potential clinical predictors and inflammatory markers within 24 h of intensive care unit (ICU) discharge to predict subsequent in-hospital mortality.
A prospective cohort study of 603 consecutive patients who survived their first ICU admission, between 1 June and 31 December 2005, in a 22-bed multidisciplinary ICU of a university hospital.
A total of 26 in-hospital deaths after ICU discharge (4.3%) were identified. C-reactive protein (CRP) concentrations at ICU discharge were associated with subsequent in-hospital mortality in the univariate analysis (mean CRP concentrations of non-survivors=174 vs. survivors=85.6 mg/l, p=0.001). CRP concentrations remained significantly associated with post-ICU mortality (a 10-mg/l increment in CRP concentrations increased the odds ratio [OR] of death: 1.09, 95% confidence interval [CI]: 1.03-1.16); after adjusting for age, the Acute Physiology and Chronic Health Evaluation (APACHE) II predicted mortality, and the Delta Sequential Organ Failure Assessment (Delta SOFA) score. The area under the receiver operating characteristic curve of this multivariate model to discriminate between survivors and non-survivors after ICU discharge was 0.85 (95% CI: 0.73-0.96). The destination and timing of ICU discharge, and the Discharge SOFA score, white cell counts and fibrinogen concentrations at ICU discharge were not significantly associated with in-hospital mortality after ICU discharge.
A high CRP concentration at ICU discharge was an independent predictor of in-hospital mortality after ICU discharge in our ICU.
评估重症监护病房（ICU）出院后24小时内潜在的临床预测指标和炎症标志物预测随后院内死亡的能力。
一项前瞻性队列研究，研究对象为2005年6月1日至12月31日期间在一所大学医院拥有22张床位的多学科ICU中首次入住ICU后存活的603例连续患者。
共确定26例ICU出院后院内死亡（4.3%）。单因素分析显示，ICU出院时的C反应蛋白（CRP）浓度与随后的院内死亡相关（非幸存者的平均CRP浓度=174 vs. 幸存者=85.6 mg/l，p=0.001）。CRP浓度仍与ICU后死亡率显著相关（CRP浓度每增加10 mg/l，死亡比值比[OR]增加：1.09，95%置信区间[CI]：1.03 - 1.16）；在调整年龄、急性生理与慢性健康状况评估（APACHE）II预测死亡率和序贯器官衰竭评估（SOFA）评分增量后。该多变量模型用于区分ICU出院后幸存者和非幸存者的受试者操作特征曲线下面积为0.85（95%CI：0.73 - 0.96）。ICU出院的目的地和时间、出院时的SOFA评分、白细胞计数和纤维蛋白原浓度与ICU出院后的院内死亡无显著相关性。
在我们ICU中，ICU出院时高CRP浓度是ICU出院后院内死亡的独立预测指标。
