Lee Jungsil, Cho Young Jae, Kim Se Joong, Yoon Ho Il, Park Jong Sun, Lee Choon Taek, Lee Jae Ho, Lee Yeon Joo
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
J Korean Med Sci. 2017 Mar;32(3):528-533. doi: 10.3346/jkms.2017.32.3.528.
We investigated the causes of inpatient death after intensive care unit (ICU) discharge and determined predictors of in-hospital mortality in Korea. Using medical ICU registry data of Seoul National University Hospital, we performed a retrospective cohort study involving patients who were discharged alive from their first ICU admission with at least 24 hours of ICU length of stay (LOS). From January 2011 to August 2013, 723 patients were admitted to ICU and 383 patients were included. The estimated in-hospital mortality rate was 11.7% (45/383). The most common cause of death was respiratory failure (n = 25, 56%) followed by sepsis and cancer progression; the causes of hospital death and ICU admission were the same in 64% of all deaths; sudden unexpected deaths comprised about one-fifth of all deaths. In order to predict in-hospital mortality among ICU survivors, multivariate analysis identified presence of solid tumor (odds ratio [OR], 4.06; 95% confidence interval [CI], 2.01-8.2; P < 0.001), hematologic disease (OR, 4.75; 95% CI, 1.51-14.96; P = 0.013), Sequential Organ Failure Assessment (SOFA) score upon ICU admission (OR, 1.08; 95% CI, 0.99-1.17; P = 0.075), and hemoglobin (Hb) level (OR, 0.67; 95% CI, 0.52-0.86; P = 0.001) and platelet count (Plt) (OR, 0.99; 95% CI, 0.99-1.00; P = 0.033) upon ICU discharge as significant factors. In conclusion, a significant proportion of in-hospital mortality is predictable and those who die in hospital after ICU discharge tend to be severely-ill, with comorbidities of hematologic disease and solid tumor, and anemic and thrombocytopenic upon ICU discharge.
我们调查了重症监护病房（ICU）出院后住院患者的死亡原因，并确定了韩国住院死亡率的预测因素。利用首尔国立大学医院的医学ICU登记数据，我们进行了一项回顾性队列研究，纳入了首次入住ICU且存活出院、ICU住院时长（LOS）至少24小时的患者。2011年1月至2013年8月，723例患者入住ICU，383例患者被纳入研究。估计住院死亡率为11.7%（45/383）。最常见的死亡原因是呼吸衰竭（n = 25，56%），其次是败血症和癌症进展；64%的死亡患者的医院死亡原因与ICU入院原因相同；突发意外死亡约占所有死亡的五分之一。为了预测ICU幸存者的住院死亡率，多因素分析确定实体瘤的存在（比值比[OR]，4.06；95%置信区间[CI]，2.01 - 8.2；P < 0.001）、血液系统疾病（OR，4.75；95% CI，1.51 - 14.96；P = 0.013）、ICU入院时的序贯器官衰竭评估（SOFA）评分（OR，1.08；95% CI，0.99 - 1.17；P = 0.075）、ICU出院时的血红蛋白（Hb）水平（OR，0.67；95% CI，0.52 - 0.86；P = 0.001）和血小板计数（Plt）（OR，0.99；95% CI，0.99 - 1.00；P = 0.033）为显著因素。总之，相当一部分住院死亡率是可预测的，ICU出院后在医院死亡的患者往往病情严重，合并血液系统疾病和实体瘤，且ICU出院时贫血和血小板减少。
