Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
Department of Emergency Medicine, College of Medicine, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
BMC Geriatr. 2018 Oct 26;18(1):259. doi: 10.1186/s12877-018-0950-9.
There has been a steady increase in the aging population and an increase in the need for long-term care beds in institutions and hospitals (LTCHs) in Korea. The aim of this study was to investigate prognosis and to identify factors contributing to mortality of critically ill patients with respiratory problems who were directly transferred to intensive care units (ICU) from LTCHs.
Following a retrospective review of clinical data and radiographic findings between July 2009 and September 2016, we included 111 patients with respiratory problems who had visited the emergency room (ER) transferred from LTCHs due to respiratory symptoms and who were then admitted to the ICU.
The mean age of the 111 patients was 79 years, and 71 patients (64%) were male. Pneumonia developed in 98 patients (88.3%), pulmonary thromboembolism in 4 (3.6%) and pulmonary tuberculosis in 3 (2.7%). Overall mortality was 19.8% (22/111). Multiple-drug-resistant (MDR) pathogens (odds ratio [OR], 17.43; 95% confidence interval [CI], 1.96-155.40) and serum albumin levels < 2.15 g/dL, which were derived through ROC (sensitivity, 72.7%; specificity, 85.4%) (OR, 28.05; 95% CI, 5.47-143.75), were independent predictors for mortality. The need for invasive ventilation (OR, 2.74; 95% CI, 1.02-7.32) and history of antibiotic use within the 3 months (OR, 3.23; 95% CI, 1.32-7.90) were risk factors for harboring MDR pathogens.
The presence of MDR pathogens and having low serum albumin levels may be poor prognostic factors in patients with respiratory problems who are admitted to the ICU from LTCHs. A history of antibiotic use within the 3 months and the need for invasive ventilation can be helpful in choosing the appropriate antibiotics to combat MDR pathogens at the time of admission.
韩国的老年人口不断增加，对机构和医院（长期护理院，LTCH）的长期护理床位的需求也在增加。本研究旨在调查患有呼吸问题的重症患者的预后，并确定导致直接从 LTCH 转入重症监护病房（ICU）的危重症患者死亡的因素。
回顾性分析 2009 年 7 月至 2016 年 9 月期间的临床资料和影像学结果，纳入 111 例因呼吸症状从 LTCH 转至急诊科（ER）并收入 ICU 的呼吸问题患者。
111 例患者的平均年龄为 79 岁，71 例（64%）为男性。98 例（88.3%）患者发生肺炎，4 例（3.6%）发生肺血栓栓塞症，3 例（2.7%）发生肺结核。总体死亡率为 19.8%（22/111）。多重耐药（MDR）病原体（比值比 [OR]，17.43；95%置信区间 [CI]，1.96-155.40）和血清白蛋白水平<2.15 g/dL（通过 ROC 得出，灵敏度为 72.7%，特异性为 85.4%）（OR，28.05；95%CI，5.47-143.75）是死亡的独立预测因子。需要有创通气（OR，2.74；95%CI，1.02-7.32）和 3 个月内使用抗生素史（OR，3.23；95%CI，1.32-7.90）是携带 MDR 病原体的危险因素。
呼吸问题患者从 LTCH 转入 ICU 时，存在 MDR 病原体和低血清白蛋白水平可能是预后不良的因素。3 个月内使用抗生素史和需要有创通气有助于在入院时选择合适的抗生素来对抗 MDR 病原体。
