Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil.
School of Public Health, University of São Paulo, São Paulo, Brazil.
Intensive Care Med. 2018 Jul;44(7):1090-1096. doi: 10.1007/s00134-018-5252-3. Epub 2018 Jul 12.
To describe long-term mortality and hospital readmissions of patients admitted to Brazilian intensive care units (ICU).
Retrospective cohort study of adult patients admitted to Brazilian hospitals affiliated to the Public Healthcare System from 10 state capitals. ICU patients were paired to non-ICU patients by frequency matching (ratio 1:2), according to postal code and admission semester. Hospitalization records were linked through deterministic linkage to national mortality data. Primary outcome was mortality up to 1 year. Other outcomes were mortality and readmissions at 30 and 90 days and 3 years. Multiple Cox regressions were used adjusting for age, sex, cancer diagnosis, type of hospital, and surgical status.
We included 324,594 patients (108,302 ICU and 216,292 non-ICU). ICU patients had increased hospital length of stay [9 (5-17) vs. 3 (1-6) days, p < 0.001] and mortality (18.5 vs. 3.6%, p < 0.001) versus non-ICU patients. One year after discharge, ICU patients were more frequently readmitted to hospital (25.4 vs. 17.4%, p < 0.001) and to ICU (31.4 vs. 7.3%, p < 0.001) than controls. Mortality up to 1 year was also higher for ICU patients (14.3 vs. 3.9%, p < 0.001). A significant interaction between surgical status and mortality was found, with adjusted hazard ratios (HRs) up to 1 year of 2.7 [95% confidence interval (CI) 2.5-2.9] for surgical patients, and 3.4 (95%CI 3.3-3.5) for medical patients. The risk for death and readmission diminished over time up to 3 years.
In a public healthcare system of a developing country, ICU patients have excessive long-term mortality and frequent readmissions. The ICU burden tended to reduce over time after hospital discharge.
描述在巴西重症监护病房（ICU）住院患者的长期死亡率和再入院率。
本回顾性队列研究纳入了来自巴西 10 个州首府的公立医院收治的成年患者。通过邮政编码和入院学期的频数匹配（1:2），将 ICU 患者与非 ICU 患者进行配对。通过确定性链接将住院记录与国家死亡率数据进行链接。主要结局是 1 年内的死亡率。其他结局是 30 天、90 天和 3 年的死亡率和再入院率。使用多 Cox 回归调整年龄、性别、癌症诊断、医院类型和手术状态。
共纳入 324594 例患者（108302 例 ICU 和 216292 例非 ICU）。与非 ICU 患者相比，ICU 患者的住院时间更长[9（5-17）vs. 3（1-6）天，p<0.001]，死亡率更高[18.5% vs. 3.6%，p<0.001]。出院后 1 年，ICU 患者再次住院（25.4% vs. 17.4%，p<0.001）和再入住 ICU（31.4% vs. 7.3%，p<0.001）的频率高于对照组。ICU 患者 1 年内的死亡率也更高（14.3% vs. 3.9%，p<0.001）。还发现手术状态与死亡率之间存在显著交互作用，调整后的 1 年危险比（HR）为手术患者 2.7（95%可信区间[CI]为 2.5-2.9），非手术患者为 3.4（95%CI 为 3.3-3.5）。在 3 年内，死亡和再入院的风险随着时间的推移而降低。
在发展中国家的公共医疗体系中，ICU 患者存在过高的长期死亡率和频繁的再入院率。ICU 负担在出院后随时间推移而逐渐减轻。
