Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
Acta Anaesthesiol Scand. 2011 Sep;55(8):962-70. doi: 10.1111/j.1399-6576.2011.02480.x. Epub 2011 Jul 20.
Chronic diseases are common among intensive care unit (ICU) patients and may worsen their prognosis. We examined the prevalence and impact of pre-admission/index morbidity among ICU patients compared with a general population cohort.
Our study encompassed all 28,172 adult patients admitted to ICUs in northern Denmark in 2005-2007 and 281,671 age- and sex-matched individuals from the general population. We used a nationwide hospital registry to obtain a 5-year history of 19 chronic diseases and computed Charlson Comorbidity Index (CCI) for each study participant and grouped them into low (CCI=0), moderate (CCI=1-2), and high (CCI=3+) morbidity levels. We computed mortality and mortality rate ratios (MRRs) adjusted for confounders, and compared the mortality between ICU patients and the general population cohort.
Low, moderate, and high pre-admission morbidity levels were present in 51.5%, 34.1%, and 14.4% of ICU patients, respectively. In these groups, 30-day mortality was 10.8%, 18.4%, and 26.7%, respectively. Three-year mortality was 21.3%, 43.1%, and 63.2%, respectively. The adjusted 30-day MRR was 1.30 [95% confidence intervals (CI): 1.21-1.39] and 1.86 (95% CI: 1.71-2.01) for ICU patients with moderate and high morbidity levels, both compared with a low morbidity level. The general population had a lower morbidity level and mortality at all morbidity levels throughout the study period. Interaction between ICU admission and high morbidity level added 5.1% to the mortality during the second and third year of follow-up.
A high pre-admission morbidity level was frequent among ICU patients and associated with a worsened prognosis. Morbidity had more impact on mortality among ICU patients compared with a general population cohort.
慢性病在重症监护病房（ICU）患者中很常见，可能会使他们的预后恶化。我们研究了 ICU 患者与一般人群相比，入院前/指数期发病的患病率和影响。
我们的研究包括 2005 年至 2007 年期间在丹麦北部 ICU 住院的所有 28172 名成年患者，以及年龄和性别匹配的 281671 名一般人群个体。我们使用国家医院登记处获得每位研究参与者的 5 年 19 种慢性疾病史，并计算 Charlson 合并症指数（CCI），并将其分为低（CCI=0）、中（CCI=1-2）和高（CCI=3+）发病水平。我们计算了死亡率和死亡率比值（MRR），并调整了混杂因素，比较了 ICU 患者和一般人群队列之间的死亡率。
低、中、高入院前发病水平分别存在于 51.5%、34.1%和 14.4%的 ICU 患者中。在这些组中，30 天死亡率分别为 10.8%、18.4%和 26.7%。3 年死亡率分别为 21.3%、43.1%和 63.2%。调整后的 30 天 MRR 为 1.30（95%置信区间：1.21-1.39）和 1.86（95%置信区间：1.71-2.01），中度和高度发病水平的 ICU 患者均高于低发病水平。整个研究期间，一般人群的发病水平和死亡率均较低。ICU 入院与高发病水平之间的相互作用使随访的第二年和第三年的死亡率增加了 5.1%。
ICU 患者入院前的高发病水平很常见，且与预后恶化有关。与一般人群队列相比，发病对 ICU 患者的死亡率影响更大。
