Frost Steven A, Alexandrou Evan, Bogdanovski Tony, Salamonson Yenna, Davidson Patricia M, Parr Michael J, Hillman Ken M
Intensive Care Liverpool Hospital, Australia; University of Western Sydney, Australia.
Resuscitation. 2009 May;80(5):505-10. doi: 10.1016/j.resuscitation.2009.02.015. Epub 2009 Apr 1.
Almost one in every 10 patients who survive intensive care will be readmitted to the intensive care unit (ICU) during the same hospitalisation. The association between increasing severity of illness (widely calculated in ICU patients) with risk of readmission to ICU has not been systematically summarized.
The meta-analysis was designed to combine information from published studies to assess the relationship between severity of illness in ICU patients and the risk of readmission to ICU during the same hospitalisation.
Studies were identified by searching MEDLINE (1966 to August 2008), EMBASE (1980-2008), and CINAHL (1982 to August 2008).
Studies included only adult populations, readmissions to ICU during the same hospitalisation and reports of valid severity of illness index.
Eleven studies (totaling 220000 patients) were included in the meta-analysis. Severity of illness (APACHE II, APACHE III, SAPS and SAPS II) measured at the time of ICU admission or discharge, was higher in patients readmitted to the ICU during the same hospitalisation compared to patients not-readmitted (both p-values<0.001). The risk of readmission to ICU increased by 43% with each standard deviation increase in severity of illness score (regardless if measured on admission to, or discharge from the ICU) (odds ratio (OR)=1.43, 95% confidence interval (CI)=1.3-1.6).
A relationship between increasing intensive care severity of illness and risk of readmission to ICU was found. The effect was the same regardless of the time of measurement of severity of illness (at admission to ICU or the time of discharge from ICU). However, further research is required to develop more comprehensive tools to identify patients at risk of readmission to ICU to allow the targeted interventions, such as ICU-outreach to follow-up these patients to minimize adverse events.
在重症监护中存活下来的患者中，几乎每10人就有1人会在同一次住院期间再次入住重症监护病房（ICU）。疾病严重程度增加（在ICU患者中广泛计算）与再次入住ICU风险之间的关联尚未得到系统总结。
本荟萃分析旨在整合已发表研究的信息，以评估ICU患者疾病严重程度与同一次住院期间再次入住ICU风险之间的关系。
通过检索MEDLINE（1966年至2008年8月）、EMBASE（1980 - 2008年）和CINAHL（1982年至2008年8月）来识别研究。
纳入的研究仅涉及成年人群、同一次住院期间再次入住ICU以及有效疾病严重程度指数报告。
荟萃分析纳入了11项研究（共220000名患者）。与未再次入住的患者相比，在同一次住院期间再次入住ICU的患者在ICU入院或出院时测量的疾病严重程度（急性生理与慢性健康状况评分系统II、急性生理与慢性健康状况评分系统III、简化急性生理学评分和简化急性生理学评分II）更高（p值均<0.001）。疾病严重程度评分每增加一个标准差，再次入住ICU 的风险增加43%（无论在ICU入院时还是出院时测量）（优势比（OR）= \alpha 1.43，95%置信区间（CI）= 1.3 - 1.6）。
发现重症监护中疾病严重程度增加与再次入住ICU风险之间存在关联。无论疾病严重程度的测量时间（在ICU入院时或ICU出院时）如何，这种影响都是相同的。然而，需要进一步研究以开发更全面的工具来识别有再次入住ICU风险的患者，以便进行有针对性的干预，例如通过ICU外展服务对这些患者进行随访，以尽量减少不良事件。
原文中“odds ratio (OR)=1.43”处“\alpha”为原文错误符号，翻译时保留原文错误。
