荷兰低风险儿科重症监护患者死亡率的相关因素
Factors Associated With Mortality in Low-Risk Pediatric Critical Care Patients in The Netherlands.
作者信息
Verlaat Carin W, Visser Idse H, Wubben Nina, Hazelzet Jan A, Lemson Joris, van Waardenburg Dick, van der Heide Douwe, van Dam Nicolette A, Jansen Nicolaas J, van Heerde Mark, van der Starre Cynthia, van Asperen Roelie, Kneyber Martin, van Woensel Job B, van den Boogaard Mark, van der Hoeven Johannes
机构信息
1Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands. 2Dutch Pediatric Intensive Care Evaluation, Department of Pediatric Intensive Care, Erasmus Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. 3Radboud University, Nijmegen, The Netherlands. 4Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. 5Department of Pediatric Intensive Care, Academic Hospital Maastricht, The Netherlands. 6Faculty Board Member, PICE Registry, the Netherlands. 7Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, The Netherlands. 8Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands. 9Department of Pediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands. 10Department of Neonatal and Pediatric Intensive Care, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands. 11Department of Pediatric Intensive Care, University Medical Center Groningen, Groningen, The Netherlands. 12Department of Pediatric Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. This work was performed at the Department of Pediatric Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.
出版信息
Pediatr Crit Care Med. 2017 Apr;18(4):e155-e161. doi: 10.1097/PCC.0000000000001086.
OBJECTIVE
To determine differences between survivors and nonsurvivors and factors associated with mortality in pediatric intensive care patients with low risk of mortality.
DESIGN
Retrospective cohort study.
SETTING
Patients were selected from a national database including all admissions to the PICUs in The Netherlands between 2006 and 2012.
PATIENTS
Patients less than 18 years old admitted to the PICU with a predicted mortality risk lower than 1% according to either the recalibrated Pediatric Risk of Mortality or the Pediatric Index of Mortality 2 were included.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
In total, 16,874 low-risk admissions were included of which 86 patients (0.5%) died. Nonsurvivors had more unplanned admissions (74.4% vs 38.5%; p < 0.001), had more complex chronic conditions (76.7% vs 58.8%; p = 0.001), were more often mechanically ventilated (88.1% vs 34.9%; p < 0.001), and had a longer length of stay (median, 11 [interquartile range, 5-32] d vs median, 3 [interquartile range, 2-5] d; p < 0.001) when compared with survivors. Factors significantly associated with mortality were complex chronic conditions (odds ratio, 3.29; 95% CI, 1.97-5.50), unplanned admissions (odds ratio, 5.78; 95% CI, 3.40-9.81), and admissions in spring/summer (odds ratio, 1.67; 95% CI, 1.08-2.58).
CONCLUSIONS
Nonsurvivors in the PICU with a low predicted mortality risk have recognizable risk factors including complex chronic condition and unplanned admissions.
目的
确定死亡率低风险的儿科重症监护患者中幸存者与非幸存者之间的差异以及与死亡相关的因素。
设计
回顾性队列研究。
设置
患者选自一个全国性数据库，该数据库包含2006年至2012年期间荷兰所有入住儿科重症监护病房（PICU）的患者。
患者
根据重新校准的儿科死亡风险或儿科死亡率指数2，入住PICU且预测死亡风险低于1%的18岁以下患者被纳入研究。
干预措施
无。
测量指标及主要结果
共纳入16874例低风险入院患者，其中86例（0.5%）死亡。与幸存者相比，非幸存者有更多计划外入院（74.4%对38.5%；p<0.001）、更多复杂慢性病（76.7%对58.8%；p = 0.001）、更常接受机械通气（88.1%对34.9%；p<0.001）且住院时间更长（中位数，11天[四分位间距，5 - 32天]对中位数，3天[四分位间距，2 - 5天]；p<0.001）。与死亡显著相关的因素有复杂慢性病（比值比，3.29；95%置信区间，1.97 - 5.50）、计划外入院（比值比，5.78；95%置信区间，3.40 - 9.81）以及春夏季入院（比值比，1.67；95%置信区间，1.08 - 2.58）。
结论
预测死亡风险低的PICU非幸存者有可识别的风险因素，包括复杂慢性病和计划外入院。
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