The University of Western Australia, Crawley, Australia.
Br J Anaesth. 2010 Apr;104(4):459-64. doi: 10.1093/bja/aeq025. Epub 2010 Feb 25.
Critical illness leading to prolonged length of stay (LOS) in an intensive care unit (ICU) is associated with significant mortality and resource utilization. This study assessed the independent effect of ICU LOS on in-hospital and long-term mortality after hospital discharge.
Clinical and mortality data of 22 298 patients, aged 16 yr and older, admitted to ICU between 1987 and 2002 were included in this linked-data cohort study. Cox's regression with restricted cubic spline function was used to model the effect of LOS on in-hospital and long-term mortality after adjusting for age, gender, acute physiology score (APS), maximum number of organ failures, era of admission, elective admission, Charlson's co-morbidity index, and diagnosis. The variability each predictor explained was calculated by the percentage of the chi(2) statistic contribution to the total chi(2) statistic.
Most hospital deaths occurred within the first few days of ICU admission. Increasing LOS in ICU was not associated with an increased risk of in-hospital mortality after adjusting for other covariates, but was associated with an increased risk of long-term mortality after hospital discharge. The variability on the long-term mortality effect associated with ICU LOS (2.3%) appeared to reach a plateau after the first 10 days in ICU and was not as important as age (35.8%), co-morbidities (18.6%), diagnosis (10.9%), and APS (3.6%).
LOS in ICU was not an independent risk factor for in-hospital mortality, but it had a small effect on long-term mortality after hospital discharge after adjustment for other risk factors.
导致 ICU 住院时间延长的重病与高死亡率和资源利用有关。本研究评估了 ICU 住院时间对出院后住院内和长期死亡率的独立影响。
这项基于数据链接的队列研究纳入了 1987 年至 2002 年间入住 ICU 的 22298 名年龄在 16 岁及以上的患者的临床和死亡率数据。使用 Cox 回归和限制三次样条函数来调整年龄、性别、急性生理评分 (APS)、最大器官衰竭数、入院时间、择期入院、Charlson 合并症指数和诊断后，建立 LOS 对住院内和长期死亡率的影响模型。通过计算 Chi(2)统计量对总 Chi(2)统计量的贡献百分比来衡量每个预测因素的可变性。
大多数医院死亡发生在 ICU 入院后的前几天。在调整其他协变量后，ICU 住院时间的增加与住院内死亡率的增加无关，但与出院后长期死亡率的增加有关。与 ICU 住院时间相关的长期死亡率的变异性（2.3%）在 ICU 住院的前 10 天似乎达到了一个平台，并且不像年龄（35.8%）、合并症（18.6%）、诊断（10.9%）和 APS（3.6%）那么重要。
ICU 住院时间不是住院内死亡率的独立危险因素，但在调整其他危险因素后，对出院后长期死亡率有一定影响。
