Campbell A J, Cook J A, Adey G, Cuthbertson B H
Department of Anaesthesia, Western Infirmary, Glasgow G11 6NT, UK.
Br J Anaesth. 2008 May;100(5):656-62. doi: 10.1093/bja/aen069. Epub 2008 Apr 2.
Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge.
This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU.
Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone.
We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.
尽管许多患者从危重病中初步康复，但在重症监护病房（ICU）出院后病情仍会恶化。我们对前瞻性收集的数据进行了研究，试图识别出重症监护出院后有再次入院或死亡风险的患者。
这是一项对从综合内科和外科（非心脏）ICU存活出院患者的临床审计数据进行的二次分析。
475例患者（11.2%）在ICU出院后死于医院。年龄增加、重症监护入院前的住院时间、急性生理与慢性健康状况评估II（APACHE II）评分以及出院时的治疗干预评分系统（TISS）评分是重症监护出院后死亡的独立危险因素。385例患者（8.8%）在同一住院期间再次入住重症监护病房。年龄增加、重症监护前的住院时间、APACHE II评分以及转至高依赖病房是再次入院的独立危险因素。143例患者（3.3%）在重症监护出院后48小时内再次入院。APACHE II评分以及转至高依赖病房或其他ICU是早期再次入院的独立危险因素。我们模型的总体判别能力中等，相较于单独的APACHE II评分仅略有优势。
我们确定了与死亡和再次入住重症监护病房相关的危险因素。基于这些危险因素，不可能生成一个用于预测个体患者死亡或再次入院的确定性模型。
