Conlon N, O'Brien B, Herbison G P, Marsh B
Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
Br J Anaesth. 2008 Feb;100(2):219-23. doi: 10.1093/bja/aem372. Epub 2007 Dec 22.
Intensive care unit (ICU) re-admission identifies a high-risk group in terms of hospital mortality, length of stay, and resource utilization. Only hospital and ICU mortality are well described in the literature on critically ill patients needing re-admission.
With ethical committee approval, from a prospectively collected database of all admissions to a combined medical and surgical ICU from January 1 to December 31, 2004, we identified all ICU re-admissions from within the hospital and analysed the factors associated with increased incidence of re-admission. At 2-3 yr after discharge, we evaluated the functional outcome of the surviving re-admitted patients as Glasgow Outcome Score (GOS) and Karnofsky index and identified determinants of both mortality and good functional outcome.
Seventy-three (7.4%) of the 1061 patients who survived their first ICU stay were re-admitted during the study period. Of the 73 re-admitted patients, 14 died in ICU, 17 died later in the same hospital stay, and 10 died in the interim. Thus, 32 (43.8%) were alive 2-3 yr after discharge. The median [IQR] GOS of the survivors was 4 (see Mackle and colleagues in One year outcome of intensive care patients with decompensated alcoholic liver disease.
Although the ICU, hospital, and subsequent mortalities are high in patients after ICU re-admission, most survivors at 2-3 yr had by then made a good functional recovery and were independent.
重症监护病房（ICU）再入院患者在医院死亡率、住院时间和资源利用方面属于高危群体。在关于需要再入院的危重症患者的文献中，仅对医院和ICU死亡率有充分描述。
经伦理委员会批准，从一个前瞻性收集的2004年1月1日至12月31日综合内科和外科ICU所有入院患者的数据库中，我们识别出医院内所有ICU再入院患者，并分析与再入院发生率增加相关的因素。出院后2至3年，我们将存活的再入院患者的功能结局评估为格拉斯哥预后评分（GOS）和卡诺夫斯基指数，并确定死亡率和良好功能结局的决定因素。
1061例首次入住ICU存活的患者中，73例（7.4%）在研究期间再次入院。在73例再入院患者中，14例在ICU死亡，17例在同一住院期间后期死亡，10例在其间死亡。因此，32例（43.8%）在出院后2至3年存活。幸存者的GOS中位数[四分位间距]为4（见Mackle及其同事所著《失代偿期酒精性肝病重症监护患者的一年结局》）。
尽管ICU再入院患者的ICU、医院及后续死亡率很高，但大多数在2至3年存活的患者届时已实现良好的功能恢复且独立生活。
