Vohra Adam S, Tak Hyo Jung, Shah Maulin B, Meltzer David O, Ruhnke Gregory W
Department of Medicine (ASV), Pritzker School of Medicine, University of Chicago, Chicago, Illinois, Department of Medicine (DOM, GWR), Section of Hospital Medicine, University of Chicago, Chicago, Illinois, Department of Health Management and Policy (HJT), University of North Texas Health Science Center, Fort Worth, Texas; and University of Pittsburgh School of Medicine (MBS), Pittsburgh, Pennsylvania.
Am J Med Sci. 2015 Nov;350(5):380-6. doi: 10.1097/MAJ.0000000000000568.
There has been a dramatic increase in the use of intensive care units (ICUs) over the past 25 years. Greater use of validated measures of illness severity may better inform ICU admission decisions in patients with community-acquired pneumonia. This article examined predictors of ICU admission and hospitalization costs, including the pneumonia severity index (PSI) and CURB-65 (confusion, uremia, respiratory rate, blood pressure, age ≥65 years) scores.
The study identified 422 patients hospitalized for community-acquired pneumonia, ascertaining patient characteristics by chart review and extraction of administrative data. Multivariate logistic regression was performed to quantify the association of the PSI, CURB-65 and comorbidities with ICU admission. The predictors of cost were estimated using a generalized linear model.
Compared to 194 general medicine patients, certain clinical and radiographic findings were more common among 228 ICU patients. Compared to PSI reference group I/II/III, ICU admission was strongly associated with risk class IV (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63-5.72) and V (OR, 4.84; CI, 2.44-9.62), and also CURB-65 ≥3 (OR, 2.90; CI, 1.51-5.56). The relative increase in mortality among PSI risk class V (compared to IV) patients was 2.68 times higher in general medicine, compared with the ICU. Among ICU admissions, risk class V was associated with an additional cost of $14,548 (95% CI, $4,232 to $24,864).
Illness severity and chronic pulmonary disease are strong predictors of ICU admission. More extensive use of the PSI may optimize site-of-care decisions, thereby minimizing mortality and unnecessary resource utilization.
在过去25年中，重症监护病房（ICU）的使用量急剧增加。更多地使用经过验证的疾病严重程度测量方法可能会更好地为社区获得性肺炎患者的ICU入院决策提供依据。本文研究了ICU入院和住院费用的预测因素，包括肺炎严重程度指数（PSI）和CURB-65（意识模糊、尿毒症、呼吸频率、血压、年龄≥65岁）评分。
该研究确定了422例因社区获得性肺炎住院的患者，通过病历审查和行政数据提取确定患者特征。进行多变量逻辑回归以量化PSI、CURB-65和合并症与ICU入院之间的关联。使用广义线性模型估计费用的预测因素。
与194例普通内科患者相比，某些临床和影像学表现在228例ICU患者中更为常见。与PSI参考组I/II/III相比，ICU入院与IV级（比值比[OR]，3.06；95%置信区间[CI]，1.63 - 5.72）和V级（OR，4.84；CI，2.44 - 9.62）风险类别密切相关，CURB-65≥3也与之相关（OR，2.90；CI，1.51 - 5.56）。在普通内科中，PSI V级（与IV级相比）患者的死亡率相对增加是ICU中的2.68倍。在ICU入院患者中，V级风险类别与额外费用14,548美元相关（95%CI，4,232美元至24,864美元）。
疾病严重程度和慢性肺病是ICU入院的有力预测因素。更广泛地使用PSI可能会优化护理地点决策，从而将死亡率和不必要的资源利用降至最低。
