酒精戒断后入住重症监护病房的患者的医疗保健利用情况。
Healthcare utilization in medical intensive care unit survivors with alcohol withdrawal.
机构信息
Division of Pulmonary Sciences and Critical Care Medicine , Department of Medicine, University of Colorado Denver, Aurora, Colorado.
出版信息
Alcohol Clin Exp Res. 2013 Sep;37(9):1536-43. doi: 10.1111/acer.12124. Epub 2013 May 3.
BACKGROUND
Rehospitalization is an important and costly outcome that occurs commonly in several diseases encountered in the medical intensive care unit (ICU). Although alcohol use disorders are present in 40% of ICU survivors and alcohol withdrawal is the most common alcohol-related reason for admission to an ICU, rates and predictors of rehospitalization have not been previously reported in this population.
METHODS
We conducted a retrospective cohort study of medical ICU survivors with a primary or secondary discharge diagnosis of alcohol withdrawal using 2 administrative databases. The primary outcome was time to rehospitalization or death. Secondary outcomes included time to first emergency department or urgent care clinic visit in the subset of ICU survivors who were not rehospitalized. Cox proportional hazard models were adjusted for age, gender, race, homelessness, smoking, and payer source.
RESULTS
Of 1,178 patients discharged from the medical ICU over the study period, 468 (40%) were readmitted to the hospital and 54 (4%) died within 1 year. Schizophrenia (hazard ratio 2.23, 95% CI 1.57, 3.34, p < 0.001), anxiety disorder (hazard ratio 2.04, 95% CI 1.30, 3.32, p < 0.01), depression (hazard ratio 1.62, 95% CI 1.05, 2.40, p = 0.03), and Deyo comorbidity score ≥3 (hazard ratio 1.43, 95% CI 1.09, 1.89, p = 0.01) were significant predictors of time to death or first rehospitalization. Bipolar disorder was associated with time to first emergency department or urgent care clinic visit (hazard ratio 2.03, 95% CI 1.24, 3.62, p < 0.01) in the 656 patients who were alive and not rehospitalized within 1 year.
CONCLUSIONS
The presence of a psychiatric comorbidity is a significant predictor of multiple measures of unplanned healthcare utilization in medical ICU survivors with a primary or secondary discharge diagnosis of alcohol withdrawal. This finding highlights the potential importance of targeting longitudinal multidisciplinary care to patients with a dual diagnosis.
背景
再入院是一个重要且昂贵的结果，在医疗重症监护病房（ICU）中遇到的几种疾病中很常见。尽管酒精使用障碍在 ICU 幸存者中占 40%，酒精戒断是 ICU 入住最常见的与酒精相关的原因，但在该人群中，再入院的发生率和预测因素尚未得到报道。
方法
我们使用 2 个行政数据库对有酒精戒断的主要或次要出院诊断的 ICU 幸存者进行了回顾性队列研究。主要结局是再入院或死亡的时间。次要结局包括在未再入院的 ICU 幸存者亚组中首次到急诊或紧急护理诊所就诊的时间。Cox 比例风险模型调整了年龄、性别、种族、无家可归、吸烟和支付来源。
结果
在研究期间从 ICU 出院的 1178 名患者中，468 名（40%）再次入院，54 名（4%）在 1 年内死亡。精神分裂症（风险比 2.23，95%CI 1.57，3.34，p<0.001）、焦虑症（风险比 2.04，95%CI 1.30，3.32，p<0.01）、抑郁症（风险比 1.62，95%CI 1.05，2.40，p=0.03）和 Deyo 合并症评分≥3（风险比 1.43，95%CI 1.09，1.89，p=0.01）是死亡或首次再入院时间的显著预测因素。双相情感障碍与 656 名在 1 年内未再入院且存活的患者首次到急诊或紧急护理诊所就诊的时间相关（风险比 2.03，95%CI 1.24，3.62，p<0.01）。
结论
精神科合并症的存在是酒精戒断的主要或次要出院诊断的 ICU 幸存者多项无计划医疗保健利用的重要预测因素。这一发现突出了针对双重诊断患者进行纵向多学科护理的潜在重要性。
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