Suchyta Mary R, Beck Callie J, Key Colin W, Jephson Al, Hopkins Ramona O
Department of Medicine, Pulmonary and Critical Care Division, LDS Hospital, Salt Lake City, UT, USA.
Intensive Care Med. 2008 Dec;34(12):2264-7. doi: 10.1007/s00134-008-1263-9. Epub 2008 Sep 18.
Substance dependence disorders are common in hospitalized patients and are associated with poor recovery. We compared mortality and discharge disposition in critically ill patients with and without substance dependence and patients with and without psychiatric disorders. We also compared the prevalence of substance dependence and psychiatric disorders to population data.
All medical records of shock trauma intensive care unit (ICU) patients (mixed medical and surgical) at LDS Hospital were reviewed for pre-critical illness alcohol dependence, drug dependence, and psychiatric disorders.
There were 742 critically ill patients of whom 54% were male, acute respiratory distress syndrome developed in 5.5% and hospital mortality was 21%. The mean acute physiology and chronic health evaluation II scores were 16.5 +/- 7.9, sequential organ failure assessment scores were 6.7 +/- 4.2, duration of mechanical ventilation was 5 +/- 6.2 days, ICU length of stay (LOS) was 7.3 +/- 10.1 days, hospital LOS was 12.3 +/- 12.9 days. Multivariable regression analyses found psychiatric disorders predicted higher hospital mortality (Odds ratio = 1.50), but was not statistically significant (p = 0.08); substance dependence predicted shorter hospital LOS (R ( 2 ) = 0.08, p = 0.01) after controlling for covariates. There was a higher prevalence of substance dependence compared to Utah (p < 0.001) and US population data (p < 0.001). The prevalence of psychiatric disorders was significantly lower in our patients compared to US population data (19 vs. 26%, p < 0.001).
Our data suggest that substance dependence increases hospital LOS and that patients with drug or alcohol dependence are at higher risk for ICU admission compared to the general population.
物质依赖障碍在住院患者中很常见，且与恢复不佳有关。我们比较了有和没有物质依赖的重症患者以及有和没有精神障碍的患者的死亡率和出院处置情况。我们还将物质依赖和精神障碍的患病率与人群数据进行了比较。
回顾了LDS医院休克创伤重症监护病房（ICU）患者（内科和外科混合）的所有病历，以了解危重病前的酒精依赖、药物依赖和精神障碍情况。
共有742例重症患者，其中54%为男性，5.5%发生急性呼吸窘迫综合征，医院死亡率为21%。急性生理与慢性健康状况评分系统II的平均评分为16.5±7.9，序贯器官衰竭评估评分为6.7±4.2，机械通气时间为5±6.2天，ICU住院时间（LOS）为7.3±10.1天，医院LOS为12.3±12.9天。多变量回归分析发现，精神障碍预示着更高的医院死亡率（优势比=1.50），但无统计学意义（p=0.08）；在控制协变量后，物质依赖预示着更短的医院LOS（R（2）=0.08，p=0.01）。与犹他州（p<0.001）和美国人群数据（p<0.001）相比，物质依赖的患病率更高。与美国人群数据相比，我们患者中的精神障碍患病率显著更低（19%对26%，p<0.001）。
我们的数据表明，物质依赖会增加医院LOS，与普通人群相比，有药物或酒精依赖的患者入住ICU的风险更高。
