Zhou Yeting, Tong Daoming, Wang Shaodan, Liu Liansong, Ye Song, Xu Benwen
Department of General Surgery, Affiliated Shuyang People's Hospital, Xuzhou Medical University, Xuzhou 223600, Jiangsu, China (Zhou YT, Ye S, Xu BW); Department of Neurology, Affiliated Shuyang People's Hospital, Xuzhou Medical University, Xuzhou 223600, Jiangsu, China (Tong DM); Department of Intensive Care Medicine, Affiliated Shuyang People's Hospital, Xuzhou Medical University, Xuzhou 223600, Jiangsu, China (Wang SD); Department of Neurosurgery, Affiliated Shuyang People's Hospital, Xuzhou Medical University, Xuzhou 223600, Jiangsu, China (Liu LS). Corresponding author: Tong Daoming, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 May;29(5):448-452. doi: 10.3760/cma.j.issn.2095-4352.2017.05.012.
To investigate the risk of death between older and non-older critical patients in intensive care unit (ICU) in Shuyang People's Hospital.
A retrospective cohort study was conducted. The critical patients who aged 15 or above, and admitted to ICU of Shuyang People's Hospital from January 2014 to December 2016 were enrolled, and all the data was collected from the registration and electronic medical records in the ICU. The prevalence and causes of death in ICU critical patients during the study period were observed. The patients were divided into elderly group (65 years and older) and non-elderly group (15-65 years), and logistic regression analysis was performed for the risk of death in the two groups.
During the study period, 2 707 critical patients in emergency were admitted to the ICU of Shuyang People's Hospital, and patients not satisfied the inclusion criteria were excluded. Finally, a total of 2 466 patients were enrolled in the analysis with the male and female ratio of 1.6 : 1, an average age of (61.8±17.3) years, a median Glasgow coma scale (GCS) score of 6 (4, 8), and with a median ICU stay of 3 (1, 6) days. In 2 466 critical patients, the most common cause of critical state was spontaneous intracerebral hemorrhage (25.5%) and traumatic brain injury (17.0%), with a fatality rate of 46.0% and 39.5% within first 7 days respectively. Compared with the non-elderly patients (n = 1 415), the incidences of death of the elderly patients (n = 1 051) due to traumatic brain injury, cerebral infarction, heart failure/cardiovascular crisis, and respiratory critically ill were significantly increased (9.4% vs. 4.7%, 2.9% vs. 0.8%, 5.0% vs. 2.1%, 2.5% vs. 1.0%, respectively), while the incidence of death for pesticide/drug poisoning in the elderly group was significantly lower than that in the non-elderly group (0.2% vs. 1.2%, all P < 0.01). Stepwise logistic regression analysis showed that traumatic brain injury [hazard ratio (HR) = 1.878, 95% confidence interval (95%CI) = 1.233-2.864, P = 0.003), cerebral infarction (HR = 0.435, 95%CI = 0.229-0.826, P = 0.011), heart failure/cardiovascular crisis (HR = 0.399, 95%CI = 0.238-0.668, P = 0.000), and respiratory critically ill (HR = 0.239, 95%CI = 0.126-0.453, P = 0.000) in the older patients were significantly high risk factors of death as compared with those in non-older patients.
In the general ICU, the most common cause is spontaneous intracerebral hemorrhage and traumatic brain injury in critical patients with a high fatality rate. The risk of death in elderly patients with severe traumatic brain injury, cerebral infarction, heart failure/cardiovascular crisis, respiratory critically ill is higher than that of the non-elderly patients.
探讨沭阳县人民医院重症监护病房（ICU）老年与非老年重症患者的死亡风险。
进行一项回顾性队列研究。纳入2014年1月至2016年12月期间年龄在15岁及以上、入住沭阳县人民医院ICU的重症患者，所有数据均从ICU的登记和电子病历中收集。观察研究期间ICU重症患者的死亡发生率及原因。将患者分为老年组（65岁及以上）和非老年组（15 - 65岁），对两组患者的死亡风险进行logistic回归分析。
研究期间，2707例急诊重症患者入住沭阳县人民医院ICU，排除不符合纳入标准的患者。最终，共2466例患者纳入分析，男女比例为1.6∶1，平均年龄（61.8±17.3）岁，格拉斯哥昏迷量表（GCS）评分中位数为6（4，8），ICU住院时间中位数为3（1，6）天。在2466例重症患者中，最常见的重症原因是自发性脑出血（25.5%）和创伤性脑损伤（17.0%），前7天内病死率分别为46.0%和39.5%。与非老年患者（n = 1415）相比，老年患者（n = 1051）因创伤性脑损伤、脑梗死、心力衰竭/心血管危象和呼吸重症导致的死亡发生率显著升高（分别为9.4%对4.7%，2.9%对0.8%，5.0%对2.1%，2.5%对1.0%），而老年组农药/药物中毒导致的死亡发生率显著低于非老年组（0.2%对1.2%，均P < 0.01）。逐步logistic回归分析显示，与非老年患者相比，老年患者的创伤性脑损伤[风险比（HR） = 1.878，95%置信区间（95%CI） = 1.233 - 2.864，P = 0.003]、脑梗死（HR = 0.435，95%CI = （0.229 - 0.826，P = 0.011）、心力衰竭/心血管危象（HR = 0.399，95%CI = 0.238 - 0.668，P = 0.000）和呼吸重症（HR = 0.239，95%CI = 0.126 - 0.453，P = 0.000）是显著的高死亡风险因素。
在综合ICU中，重症患者最常见的病因是自发性脑出血和创伤性脑损伤，病死率较高。老年患者发生严重创伤性脑损伤、脑梗死、心力衰竭/心血管危象、呼吸重症时的死亡风险高于非老年患者。
