Gacouin Arnaud, Maamar Adel, Fillatre Pierre, Sylvestre Emmanuelle, Dolan Margaux, Le Tulzo Yves, Tadié Jean Marc
Service des Maladies Infectieuses et Réanimation Médicale, Maladies Infectieuses et Réanimation Médicale, CHU Rennes, 35033, Rennes, France.
Faculté de Médecine, Biosit, Université Rennes 1, 35043, Rennes, France.
Ann Intensive Care. 2017 Dec;7(1):1. doi: 10.1186/s13613-016-0221-x. Epub 2017 Jan 3.
While the psychiatric disorders are conditions frequently encountered in hospitalized patients, there are little or no data regarding the characteristics and short- and long-term outcomes in patients with preexisting psychiatric disorders in ICU. Such assessment may provide the opportunity to determine the respective impact on mortality in the ICU and after ICU discharge with reasons for admission, including modalities of self-harm, of underlying psychiatric disorders and prior psychoactive medications.
ICU and 1-year survival analysis performed on a retrospective cohort of patients with preexisting psychiatric disorders admitted from 2000 through 2013 in a 21-bed polyvalent ICU in a university hospital.
Among the 1751 patients of the cohort, 1280 (73%) were admitted after deliberate self-harm. Psychiatric diagnoses were: schizophrenia, n = 97 (6%); non-schizophrenia psychotic disorder, n = 237 (13%); depression disorder, n = 1058 (60%), bipolar disorder, n = 172 (10%), and anxiety disorder, n = 187 (11%). ICU mortality rate was significantly lower in patients admitted after self-harm than in patients admitted for other reasons than self-harm [38/1288 patients (3%) vs. 53/463 patients (11%), respectively, p < 0.0001]. Compared with patients admitted for deliberate self-poisoning with psychoactive medications, patients admitted for self-harm by hanging, drowning, jumping from buildings, or corrosive chemicals ingestion had a significantly higher ICU mortality rate. In the ICU, SAPS II score [adjusted odds ratio (OR) 1.061, 95% CI 1.041-1.079, p < 0.0001], use of vasopressors (adjusted OR 7.40, 95% CI 2.94-18.51, p < 0.001), out-of-hospital cardiac arrest (adjusted OR 14.70, 95% CI 3.86-38.51, p < 0.001), and self-harm by hanging, drowning, jumping from buildings, or corrosive chemicals ingestion (adjusted OR 11.49, 95% CI 3.76-35.71, p < 0.001) were independently associated with mortality. After ICU discharge SAPS II score [adjusted hazard ratio (HR) 1.023, 95% CI 1.010-1.036, p < 0.01], age (adjusted HR 1.030, 95% CI 1.016-1.044, p < 0.0001), admission for respiratory failure (adjusted HR 2.23, 95% CI 1.19-4.57, p = 0.01), and shock (adjusted HR 3.72, 95% CI 1.97-6.62, p < 0.001) were independently associated with long-term mortality. Neither psychiatric diagnoses nor psychoactive medications received before admission to the ICU were independently associated with mortality.
The study provides data on the short- and long-term outcomes of patients with prepsychiatric disorders admitted to the ICU that may guide decisions when considering ICU admission and discharge in these patients.
虽然精神疾病是住院患者中常见的病症，但关于重症监护病房（ICU）中已有精神疾病患者的特征以及短期和长期预后的数据很少或几乎没有。这样的评估可能提供机会来确定潜在精神疾病及其既往使用精神活性药物（包括自我伤害方式）对ICU死亡率以及ICU出院后死亡率的各自影响，并分析入院原因。
对2000年至2013年期间在一家大学医院拥有21张床位的综合ICU收治的已有精神疾病患者的回顾性队列进行ICU和1年生存分析。
在该队列的1751名患者中，1280名（73%）因故意自我伤害入院。精神疾病诊断包括：精神分裂症，n = 97（6%）；非精神分裂症性精神病性障碍，n = 237（13%）；抑郁症，n = 1058（60%），双相情感障碍，n = 172（10%），以及焦虑症，n = 187（11%）。自我伤害后入院的患者的ICU死亡率显著低于因其他原因而非自我伤害入院的患者[分别为1288例患者中的38例（3%）和463例患者中的53例（11%），p < 0.0001]。与因使用精神活性药物故意自我中毒入院的患者相比，因上吊、溺水、跳楼或摄入腐蚀性化学品进行自我伤害入院的患者的ICU死亡率显著更高。在ICU中，简化急性生理学评分（SAPS）II [调整后的比值比（OR）1.061，95%置信区间（CI）1.041 - 1.079，p < 0.0001]、使用血管升压药（调整后的OR 7.40，95% CI 2.94 - 18.51，p < 0.001）、院外心脏骤停（调整后的OR 14.70，95% CI 3.86 - 38.51，p < 0.001）以及因上吊、溺水、跳楼或摄入腐蚀性化学品进行自我伤害（调整后的OR 11.49，95% CI 3.76 - 35.71，p < 0.001）与死亡率独立相关。ICU出院后，SAPS II评分[调整后的风险比（HR）1.023，95% CI 1.010 - 1.036，p < 0.01]、年龄（调整后的HR 1.030，95% CI 1.016 - 1.044，p < 0.0001）、因呼吸衰竭入院（调整后的HR 2.23，95% CI 1.19 - 4.57，p = 0.01）以及休克（调整后的HR 3.72，95% CI 1.97 - 6.62，p < 0.001）与长期死亡率独立相关。ICU入院前的精神疾病诊断和使用的精神活性药物均与死亡率无独立相关性。
该研究提供了关于入住ICU的已有精神疾病患者的短期和长期预后的数据，这可能为考虑这些患者的ICU入院和出院决策提供指导。
