年龄、SAPS 3 和女性性别与是否决定停止或停止重症监护有关。

Age, SAPS 3 and female sex are associated with decisions to withdraw or withhold intensive care.

机构信息

Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.

出版信息

Acta Anaesthesiol Scand. 2019 Oct;63(9):1210-1215. doi: 10.1111/aas.13411. Epub 2019 Jun 13.

DOI:10.1111/aas.13411

PMID:31190331

Abstract

BACKGROUND

Intensive care treat critically ill patients. When intensive care is not considered beneficial for the patient, decisions to withdraw or withhold treatments are made. We aimed to identify independent patient variables that increase the odds for receiving a decision to withdraw or withhold intensive care.

METHODS

Registry study using data from the Swedish Intensive Care Registry (SIR) 2014-2016. Age, condition at admission, including co-morbidities (Simplified Acute Physiology Score version 3, SAPS 3), diagnosis, sex, and decisions on treatment limitations were extracted. Patient data were divided into a full care (FC) group, and a withhold or withdraw (WW) treatment group.

RESULTS

Of all 97 095 cases, 47.1% were 61-80 years old, 41.9% were women and 58.1% men. 14 996 (15.4%) were allocated to the WW group and 82 149 (84.6%) to the FC group. The WW group, compared with the FC group, was older (P < 0.001), had higher SAPS 3 (P < 0.001) and were predominantly female (P < 0.001). Compared to patients 16-20 years old, patients >81 years old had 11 times higher odds of being allocated to the WW group. Higher SAPS 3 (continuous) increased the odds of being allocated to the WW group by odds ratio [OR] 1.085, (CI 1.084-1.087). Female sex increased the odds of being allocated to the WW group by 18% (1.18; CI 1.13- 1.23).

CONCLUSION

Older age, higher SAPS 3 at admission and female sex were found to be independent variables that increased the odds to receive a decision to withdraw or withhold intensive care.

摘要

背景

重症监护治疗危重病患者。当重症监护被认为对患者无益时，会做出停止或撤回治疗的决定。我们的目的是确定增加接受停止或撤回重症监护决定几率的独立患者变量。

方法

使用瑞典重症监护登记处（SIR）2014-2016 年的数据进行登记研究。提取年龄、入院时的情况，包括合并症（简化急性生理学评分第 3 版，SAPS 3）、诊断、性别以及治疗限制的决定。患者数据分为全治疗（FC）组和停止或撤回（WW）治疗组。

结果

在所有 97095 例患者中，47.1%为 61-80 岁，41.9%为女性，58.1%为男性。14996 例（15.4%）被分配到 WW 组，82149 例（84.6%）被分配到 FC 组。与 FC 组相比，WW 组年龄更大（P<0.001），SAPS 3 更高（P<0.001），且主要为女性（P<0.001）。与 16-20 岁的患者相比，81 岁以上的患者被分配到 WW 组的几率高 11 倍。SAPS 3 越高（连续），被分配到 WW 组的几率越高，比值比（OR）为 1.085（CI 1.084-1.087）。女性性别使被分配到 WW 组的几率增加 18%（1.18；CI 1.13-1.23）。