外科重症患者症状性上消化道出血的发病率、结局及死亡风险因素（泰国重症监护病房研究）

Incidence, Outcomes and Risk Factors for Mortality of Symptomatic upper Gastrointestinal Hemorrhage in Surgical Critical Ill Patients (THAI SICU Study).

作者信息

Kitsiripant Chanatthee, Chittawatanarat Kaweesak, Chatmongkolchart Sunisa, Akaraborworn Osaree

出版信息

J Med Assoc Thai. 2016 Sep;99 Suppl 6:S170-S177.

Abstract

OBJECTIVE

This multicenter university-based study reports the incidence, outcomes and defined risk factors for mortality of upper gastrointestinal hemorrhage (UGIH) patients in the surgical intensive care units (ICU) patients in Thailand.

MATERIAL AND METHOD

This is part of a multicenter prospective observational study in the ICU in Thailand (THAI-SICU study). Patients who had a clinical presentation of upper gastrointestinal hemorrhage or an endoscopic diagnosis from April 2011 to January 2013 were enrolled into this sub-study.

RESULTS

A total of 4,652 patients were analyzed. Fifty-five patients (1.18%) had symptomatic UGIH during ICU admission. The median age (interquartile range, IQR) was 72 (63-78) years old and the median APACHE II score (IQR) was 17 (13-22). In a comparison between the UGIH patients who survived and those who non-survived APACHE II score were higher in the non-survivors. The ICU mortality rate and 28-day mortality rate in these patients were 30.91% and 40%, respectively. In multivariable model, UGIH was significantly associated with 28-day mortality [adjusted odds ratio, OR, (95% confidence interval, CI): 1.99 (1.02 to 3.88); p = 0.043] and ICU length of stay [adjusted coefficient (95% CI): 9.36 (8.03 to 10.70); p<0.001]. Regarding the exploratory model, the significant risk factors for non-survived of UGIH patients were coagulopathy especially platelet count <50,000 [OR (95% CI): 3.96 (1.07-14.67); p = 0.039] and INR >1.5 [5 (1.04-23.98); p = 0.044], renal failure [6.48 (1.37-30.61); p = 0.018], APACHE II score [1.11 (1.02-1.22); p = 0.020] and vasopressor use [5.78 (1.6-37.18); p = 0.013].

CONCLUSION

The incidence of symptomatic UGIH in the THAI-SICU study was 1.18% and UGIH was associated with higher 28-day mortality rate and prolonged ICU length of stay. The risk factors for mortality were coagulopathy, renal failure, APACHE II score and vasopressor use.

摘要

目的

本项基于大学的多中心研究报告了泰国外科重症监护病房（ICU）中上消化道出血（UGIH）患者的发病率、转归及明确的死亡风险因素。

材料与方法

这是泰国ICU多中心前瞻性观察性研究（THAI-SICU研究）的一部分。纳入了2011年4月至2013年1月期间有上消化道出血临床表现或经内镜诊断的患者进入本亚研究。

结果

共分析了4652例患者。55例患者（1.18%）在ICU住院期间出现有症状的UGIH。中位年龄（四分位间距，IQR）为72（63 - 78）岁，中位急性生理与慢性健康状况评分系统II（APACHE II）评分（IQR）为17（13 - 22）。存活的UGIH患者与未存活患者相比，未存活者的APACHE II评分更高。这些患者的ICU死亡率和28天死亡率分别为30.91%和40%。在多变量模型中，UGIH与28天死亡率显著相关[调整后的比值比，OR，（95%置信区间，CI）：1.99（1.02至3.88）；p = 0.043]以及ICU住院时间[调整系数（95%CI）：9.36（8.03至10.70）；p<0.001]。关于探索性模型，UGIH患者未存活的显著风险因素为凝血功能障碍，尤其是血小板计数<50,000[OR（95%CI）：3.96（1.07 - 14.67）；p = 0.039]和国际标准化比值（INR）>1.5[5（1.04 - 23.98）；p = 0.044]、肾衰竭[6.48（1.37 - 30.61）；p = 0.018]、APACHE II评分[1.11（1.02 - 1.22）；p = 0.020]以及血管活性药物的使用[5.78（1.6 - 37.18）；p = 0.013]。