Ghelani Dhaval, Moran John L, Sloggett Andy, Leeson Richard J, Peake Sandra L
Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
J Eval Clin Pract. 2009 Jun;15(3):425-35. doi: 10.1111/j.1365-2753.2008.01030.x. Epub 2009 Apr 2.
Long-term post-hospital survival of intensive care cohorts has been poorly characterized. The relative survival of septic and non-septic intensive care and general hospital patient cohorts, compared with the Australian population, was determined.
A retrospective cohort study in a tertiary-level adult intensive care. Index intensive care admissions, July 1993 to June 1999, with sepsis and surviving hospital, constituted the intensive care sepsis cohort; residual patients, the intensive care non-sepsis cohort. Hospital cohorts, infected and non-infected, and Charlson Comorbidity Score (CCS) were obtained electronically, from ICD-9 codes. Follow-up was until death, or for a minimum of 4.2 years, to a maximum of 9.6 years. Time-to-death was sourced from the State registry. Relative survival was determined using the Esteve method and excess hazard modelled by covariate adjusted generalized linear models.
The ICU sepsis (n = 224) and non-sepsis (n = 1798) cohorts were of mean (standard deviation, SD) age of 63.2 (15.6) and 59.8 (18.9) years; with co-morbidity score 1.2 (1.3) and 0.5 (0.9) respectively. Hospitalized infected (n = 8455) and non-infected (n = 51,152) cohorts were of age 56.5 (22.2) and 52.2 (20.9) years; co-morbidity score 0.4 (0.9) and 0.3 (0.9) respectively. Relative survival of all cohorts was less than the Australian population; for the two intensive care cohorts, progressive relative survival decline suggested a perpetuating excess mortality. Both age and CCS increments were associated with progressive increases in excess hazard. There was a reduced hazard for intensive care sepsis versus non-sepsis cohorts; 0.42 [95% confidence interval (CI): 0.25-0.71, P = 0.001] and surgical versus medical patients, 0.64 (95% CI: 0.50-0.84, P = 0.001); and an excess hazard for men, 1.38 (95% CI: 1.08-1.74, P = 0.009).
Adverse long-term survival of intensive care and hospital patients was demonstrated. For hospital patients there was additional infection-related mortality risk, not evident for ICU patients after case mix control.
重症监护队列的长期院外生存率一直未得到充分描述。本研究确定了脓毒症和非脓毒症重症监护及综合医院患者队列与澳大利亚人群相比的相对生存率。
在一家三级成人重症监护病房进行回顾性队列研究。1993年7月至1999年6月入住重症监护病房且患有脓毒症并存活出院的患者构成重症监护脓毒症队列；其余患者构成重症监护非脓毒症队列。通过ICD-9编码以电子方式获取医院队列（感染和未感染患者）及查尔森合并症评分（CCS）。随访至死亡，或至少4.2年，最长9.6年。死亡时间来自州登记处。使用埃斯特韦方法确定相对生存率，并通过协变量调整的广义线性模型对超额风险进行建模。
重症监护脓毒症队列（n = 224）和非脓毒症队列（n = 1798）的平均（标准差，SD）年龄分别为63.2（15.6）岁和59.8（18.9）岁；合并症评分分别为1.2（1.3）和0.5（0.9）。住院感染队列（n = 8455）和未感染队列（n = 51152）的年龄分别为56.5（22.2）岁和52.2（20.9）岁；合并症评分分别为0.4（0.9）和0.3（0.9）。所有队列的相对生存率均低于澳大利亚人群；对于两个重症监护队列，相对生存率逐渐下降表明存在持续的超额死亡率。年龄和CCS的增加均与超额风险的逐渐增加相关。重症监护脓毒症队列与非脓毒症队列相比风险降低；0.42[95%置信区间（CI）：0.25 - 0.71，P = 0.001]，外科患者与内科患者相比，0.64（95%CI：0.50 - 0.84，P = 0.001）；男性存在超额风险，1.38（95%CI：1.08 - 1.74，P = 0.009）。
证明了重症监护患者和医院患者长期生存情况不佳。对于医院患者，存在额外的感染相关死亡风险，在病例组合控制后，重症监护病房患者中未观察到这一情况。
