因大流行性流感导致急性肺损伤（ALI）与其他病因相比在重症监护病房的相对费用和结局：一项单中心研究。

Relative cost and outcomes in the intensive care unit of acute lung injury (ALI) due to pandemic influenza compared with other etiologies: a single-center study.

机构信息

Resident, Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA.

出版信息

Ann Intensive Care. 2012 Aug 28;2(1):41. doi: 10.1186/2110-5820-2-41.

DOI:10.1186/2110-5820-2-41

PMID:22929215

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3503790/

Abstract

BACKGROUND

Critical illness due to 2009 H1N1 influenza has been characterized by respiratory complications, including acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), and associated with high mortality. We studied the severity, outcomes, and hospital charges of patients with ALI/ARDS secondary to pandemic influenza A infection compared with ALI and ARDS from other etiologies.

METHODS

A retrospective review was conducted that included patients admitted to the Cleveland Clinic MICU with ALI/ARDS and confirmed influenza A infection, and all patients admitted with ALI/ARDS from any other etiology from September 2009 to March 2010. An itemized list of individual hospital charges was obtained for each patient from the hospital billing office and organized by billing code into a database. Continuous data that were normally distributed are presented as the mean ± SD and were analyzed by the Student's t test. The chi-square and Fisher exact tests were used to evaluate differences in proportions between patient subgroups. Data that were not normally distributed were compared with the Wilcoxon rank-sum test.

RESULTS

Forty-five patients were studied: 23 in the H1N1 group and 22 in the noninfluenza group. Mean ± SD age was similar (44 ± 13 and 51 ± 17 years, respectively, p = 0.15). H1N1 patients had lower APACHE III scores (66 ± 20 vs. 89 ± 32, p = 0.015) and had higher Pplat and PEEP on days 1, 3, and 14. Hospital and ICU length of stay and duration of mechanical ventilation were comparable. SOFA scores over the first 2 weeks in the ICU indicate more severe organ failure in the noninfluenza group (p = 0.017). Hospital mortality was significantly higher in the noninfluenza group (77 vs. 39%, p = 0.016). The noninfluenza group tended to have higher overall charges, including significantly higher cost of blood products in the ICU.

CONCLUSIONS

ALI/ARDS secondary to pandemic influenza infection is associated with more severe respiratory compromise but has lower overall acuity and better survival rates than ALI/ARDS due to other causes. Higher absolute charges in the noninfluenza group are likely due to underlying comorbid medical conditions.

摘要

背景

2009 年 H1N1 流感引起的危重症的特点是呼吸并发症，包括急性肺损伤（ALI）或急性呼吸窘迫综合征（ARDS），并且死亡率较高。我们研究了与其他病因引起的 ALI 和 ARDS 相比，大流行性流感 A 感染引起的 ALI/ARDS 患者的严重程度、结局和住院费用。

方法

对 2009 年 9 月至 2010 年 3 月期间因 ALI/ARDS 入住克利夫兰诊所 MICU 且确诊为甲型流感感染的患者以及因任何其他病因入住 ALI/ARDS 的所有患者进行回顾性分析。从医院计费办公室获得每位患者的个别医院费用清单，并按计费代码组织到数据库中。正态分布的连续数据以均数±标准差表示，并通过学生 t 检验进行分析。使用卡方检验和 Fisher 确切概率法比较患者亚组之间的比例差异。非正态分布的数据采用 Wilcoxon 秩和检验进行比较。

结果

共纳入 45 例患者：H1N1 组 23 例，非流感组 22 例。平均年龄相似（分别为 44±13 和 51±17 岁，p=0.15）。H1N1 患者的急性生理和慢性健康状况评分Ⅲ（APACHE Ⅲ）评分较低（分别为 66±20 和 89±32，p=0.015），且第 1、3 和 14 天的平台压（Pplat）和呼气末正压（PEEP）较高。住院和 ICU 住院时间以及机械通气时间无差异。入住 ICU 前 2 周的 SOFA 评分表明非流感组的器官衰竭更为严重（p=0.017）。非流感组的院内死亡率明显更高（77%比 39%，p=0.016）。非流感组的总费用较高，包括 ICU 血液制品的费用显著较高。