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非计划入住重症监护病房患者的结局及预后因素。

The outcomes and prognostic factors of the patients with unplanned intensive care unit readmissions.

作者信息

Lin Wei-Ting, Chen Wan-Ling, Chao Chien-Ming, Lai Chih-Cheng

机构信息

Departments of Orthopedics and Trauma Department of Respiratory Therapy Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.

出版信息

Medicine (Baltimore). 2018 Jun;97(26):e11124. doi: 10.1097/MD.0000000000011124.

Abstract

This retrospective cohort study investigated the outcomes of patients with unplanned intensive care unit (ICU) readmission.All of the patients readmitted to ICU within 48 hours between 2010 and 2016 were enrolled.A total of 99 patients early readmitted to ICU were identified and their mean age of the patients was 68.8 ± 14.8 years. Respiratory failure was the most common cause of ICU readmission (n = 48, 48.5%), followed by acute myocardial ischemia or worsening heart failure (n = 25, 25.3%), sepsis (n = 22, 22.2%), gastrointestinal disease (n = 16, 16.2%), and neurologic disease (n = 11, 11.1%). The median length of stay in the ICU and hospital was 7 (IQR, 4-11.5) and 32 (IQR, 15.5-48.5) days, respectively. A total of 34 patients died during the hospital stay and the rate of in-hospital mortality was 34.3%. Patients with higher APACHE II scores (adjusted odds ratio [OR], 1.17; 95% CI, 1.02-1.33), underlying malignancy (adjusted OR, 4.70; 95% CI, 1.19-18.57), and cardiovascular organ dysfunction (adjusted OR, 5.14; 95% CI, 1.24-21.38) were more likely to die.The mortality rate of ICU readmission patients was high, especially for those with higher APACHE II score, underlying malignancy and cardiovascular organ dysfunction.

摘要

这项回顾性队列研究调查了非计划入住重症监护病房(ICU)患者的结局。纳入了2010年至2016年间在48小时内再次入住ICU的所有患者。共确定了99例早期再次入住ICU的患者,其平均年龄为68.8±14.8岁。呼吸衰竭是ICU再入院最常见的原因(n = 48,48.5%),其次是急性心肌缺血或心力衰竭恶化(n = 25,25.3%)、脓毒症(n = 22,22.2%)、胃肠道疾病(n = 16,16.2%)和神经系统疾病(n = 11,11.1%)。ICU和医院的中位住院时间分别为7天(四分位间距,4 - 11.5天)和32天(四分位间距,15.5 - 48.5天)。共有34例患者在住院期间死亡,住院死亡率为34.3%。急性生理与慢性健康状况评分系统(APACHE)II评分较高(调整优势比[OR],1.17;95%置信区间[CI],1.02 - 1.33)、存在潜在恶性肿瘤(调整OR,4.70;95% CI,1.19 - 18.57)和心血管器官功能障碍(调整OR,5.14;95% CI,1.24 - 21.38)的患者死亡可能性更大。ICU再入院患者的死亡率很高,尤其是那些APACHE II评分较高、存在潜在恶性肿瘤和心血管器官功能障碍的患者。

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