Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Intensive Care Med. 2020 Apr;35(4):386-393. doi: 10.1177/0885066617754046. Epub 2018 Jan 22.
Acute poisoning represents a major cause of morbidity and mortality, and many of these patients are admitted to the intensive care unit (ICU). However, little is known regarding ICU costs of acute poisoning.
This was a retrospective matched database analysis of patients admitted to the ICU with acute poisoning from 2011 to 2014. It was performed in 2 ICUs within a single tertiary care hospital system. All patient information, outcomes, and costs were stored in the hospital data warehouse. Control patients were defined as randomly selected age-, sex-, severity index-, and comorbidity index-matched nonpoisoned ICU patients (1:4 matching ratio).
A total of 8452 critically ill patients were admitted during the study period, of whom 277 had a diagnosis of acute poisoning. The mean age was 44.5 years, and the most common xenobiotics implicated were sedative hypnotics (20.2%), antidepressants (15.2%), and opioids (10.5%). Of these, 73.6% of poisonings were deemed intentional. In-hospital mortality of poisoned patients was 5.1%, compared to 11.1% for control patients ( < .01). The median ICU length of stay (LOS) for poisoned patients was 3.0 days, compared with 4.0 days for control patients ( < .01). The mean total cost for poisoned patients was CAD$18 958. Control patients had a significantly higher mean total cost of CAD$60 628 ( < .01). The xenobiotics associated with the highest costs were acetaminophen (CAD$18 585), toxic alcohols (CAD$16 771), and opioids (CAD$12 967).
In our cohort, we confirmed the long-held belief that patients admitted to the ICU with a primary diagnosis of poisoning have a lower mortality rate, ICU LOS, and overall cost per ICU admission than nonpoisoned patients. However, poisoned patients still accrue significant daily costs, with the highest costs attributed to xenobiotics with known antidotes, such as acetaminophen, toxic alcohols, and opioids.
急性中毒是发病率和死亡率的主要原因之一，许多此类患者都需要入住重症监护病房（ICU）。然而，目前对于急性中毒患者 ICU 费用的了解甚少。
这是一项对 2011 年至 2014 年期间入住 ICU 的急性中毒患者进行的回顾性匹配数据库分析。该研究在一家三级保健医院系统内的 2 个 ICU 中进行。所有患者的信息、结局和费用都存储在医院数据仓库中。对照患者定义为随机选择的年龄、性别、严重程度指数和合并症指数匹配的非中毒性 ICU 患者（1:4 匹配比例）。
在研究期间，共有 8452 名危重症患者入住 ICU，其中 277 名患者被诊断为急性中毒。患者的平均年龄为 44.5 岁，最常见的外源性物质为镇静催眠药（20.2%）、抗抑郁药（15.2%）和阿片类药物（10.5%）。其中，73.6%的中毒是故意的。中毒患者的院内死亡率为 5.1%，而对照患者为 11.1%（<0.01）。中毒患者的 ICU 住院时间中位数为 3.0 天，而对照患者为 4.0 天（<0.01）。中毒患者的平均总费用为 18958 加元。对照患者的平均总费用明显较高，为 60628 加元（<0.01）。与费用最高相关的外源性物质是对乙酰氨基酚（18585 加元）、有毒醇类（16771 加元）和阿片类药物（12967 加元）。
在我们的队列中，我们证实了长期以来的观点，即因中毒而被收入 ICU 的患者的死亡率、ICU 住院时间和 ICU 入院的总体费用均低于非中毒患者。然而，中毒患者的每日费用仍然很高，其中费用最高的是有明确解毒剂的外源性物质，如对乙酰氨基酚、有毒醇类和阿片类药物。
