Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
PLoS One. 2019 Jan 24;14(1):e0211240. doi: 10.1371/journal.pone.0211240. eCollection 2019.
Intensive care unit (ICU) readmission is generally associated with increased hospital stays and increased mortality. However, there are limited data on ICU readmission in critically ill cancer patients.
We conducted a retrospective cohort study based on the prospective registry of all critically ill cancer patients admitted to the oncology medical ICU between January 2012 and December 2013. After excluding patients who were discharged to another hospital or decided to end-of-life care, we divided the enrolled patients into four groups according to the time period from ICU discharge to unexpected events (ICU readmission or ward death) as follows: no (without ICU readmission or death, n = 456), early (within 2 days, n = 42), intermediate (between 2 and 7 days, n = 64), and late event groups (after 7 days of index ICU discharge, n = 129). The independent risk factors associated with ICU readmission or unexpected death after ICU discharge were also analyzed using multinomial logistic regression model.
There were no differences in the reasons for ICU readmission across the groups. ICU mortality did not differ among the groups, but hospital mortality was significantly higher in the late event group than in the early event group. Mechanical ventilation during ICU stay, tachycardia, decreased mental status, and thrombocytopenia on the day of index ICU discharge increased the risk of early ICU readmission or unexpected ward death, while admission through the emergency room and sepsis and respiratory failure as the reasons for index ICU admission were associated with increased risk of late readmission or unexpected ward death. Interestingly, recent chemotherapy within 4 weeks before index ICU admission was inversely associated with the risk of late readmission or unexpected ward death.
In critically ill cancer patients, patient characteristics predicting ICU readmission or unexpected ward death were different according to the time period between index ICU discharge and the events.
重症监护病房（ICU）再入院通常与住院时间延长和死亡率增加有关。然而，危重症癌症患者 ICU 再入院的相关数据有限。
我们进行了一项回顾性队列研究，基于 2012 年 1 月至 2013 年 12 月期间所有入住肿瘤科 ICU 的危重症癌症患者的前瞻性登记。排除出院至其他医院或决定临终关怀的患者后，根据 ICU 出院至意外事件（ICU 再入院或病房死亡）的时间将纳入的患者分为四组：无（无 ICU 再入院或死亡，n = 456）、早期（2 天内，n = 42）、中期（2 至 7 天，n = 64）和晚期事件组（索引 ICU 出院后 7 天，n = 129）。还使用多项逻辑回归模型分析了与 ICU 出院后 ICU 再入院或意外死亡相关的独立危险因素。
各组 ICU 再入院的原因无差异。各组 ICU 死亡率无差异，但晚期事件组的医院死亡率明显高于早期事件组。ICU 住院期间机械通气、心动过速、精神状态下降和指数 ICU 出院日血小板减少增加了早期 ICU 再入院或意外病房死亡的风险，而通过急诊室入院和脓毒症和呼吸衰竭作为指数 ICU 入院的原因与晚期再入院或意外病房死亡的风险增加相关。有趣的是，指数 ICU 入院前 4 周内最近接受化疗与晚期再入院或意外病房死亡的风险呈负相关。
在危重症癌症患者中，根据指数 ICU 出院和事件之间的时间间隔，预测 ICU 再入院或意外病房死亡的患者特征不同。
