Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei City, Taiwan.
Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan; Department of Neurosurgery, Shuang Ho Hospital, New-Taipei City, Taiwan.
Am J Emerg Med. 2020 May;38(5):953-957. doi: 10.1016/j.ajem.2019.158362. Epub 2019 Jul 23.
Sepsis patients require timely and appropriate treatment in an intensive care setting. However, "do-not-attempt resuscitation" (DNAR) status may affect physicians' priorities and treatment preferences. The aim of this study was to evaluate whether DNAR status affects the outcomes of septic patients.
This was a retrospective cohort study included septic patients admitted to the emergency department intensive care unit (ED-ICU) in a university-based teaching hospital during April-November 2015. Septic patients admitted to the ED-ICU were included.
Of the 132 eligible patients, 49.2% (65/132) had DNAR status (median age 80 years old, IQR, 73-86). The overall in-hospital mortality rate was 28.8% (38/132). Non-survivors had a higher percentage of receiving inotropes/vasopressors (52.6% vs 34.0%, p = 0.048), higher median Charlson comorbidity index scores [8.5 (IQR, 7-11.75) vs 8 (IQR, 6-9), p = 0.012], higher APACHE II score [25 (IQR, 20-30.25) vs 20 (IQR, 17-25), p = 0.002], and higher SOFA score [7 (IQR, 6-11) vs 6 (IQR,4-8), p = 0.012]. There was no significant difference in intubation among the two groups. In a multivariate logistic regression analysis, DNAR status was an independent predictor of in-hospital mortality (odds ratio = 6.22, 95% confidence interval (CI) = (2.71-17.88), p < 0.001). The area under the ROC curve for the logistic regression model was 0.84 [95% CI = (0.77-0.92), p < 0.001]. In subgroup analysis, DNAR status remained an independent predictor of mortality among age ≥65 years and ≥80 years.
After adjusting for comorbidities, treatments, and illness severity, DNAR status was associated with in-hospital mortality of septic patients. Further studies should evaluate physicians' attitudes toward septic patients with DNAR status.
脓毒症患者需要在重症监护病房（ICU）中得到及时和适当的治疗。然而，“不尝试复苏”（DNAR）状态可能会影响医生的治疗优先级和治疗偏好。本研究旨在评估 DNAR 状态是否会影响脓毒症患者的预后。
这是一项回顾性队列研究，纳入了 2015 年 4 月至 11 月期间在一所大学附属医院急诊 ICU（ED-ICU）收治的脓毒症患者。纳入 ED-ICU 收治的脓毒症患者。
在 132 名符合条件的患者中，49.2%（65/132）有 DNAR 状态（中位年龄 80 岁，IQR，73-86）。总的院内死亡率为 28.8%（38/132）。非幸存者接受血管活性药物（血管加压素/正性肌力药物）的比例更高（52.6% vs 34.0%，p=0.048），Charlson 合并症指数评分中位数更高[8.5（IQR，7-11.75）vs 8（IQR，6-9），p=0.012]，急性生理学与慢性健康状况评分系统 II 评分更高[25（IQR，20-30.25）vs 20（IQR，17-25），p=0.002]，序贯器官衰竭评估评分更高[7（IQR，6-11）vs 6（IQR，4-8），p=0.012]。两组之间插管率无显著差异。多变量 logistic 回归分析显示，DNAR 状态是院内死亡的独立预测因素（比值比=6.22，95%置信区间（CI）=（2.71-17.88），p<0.001）。logistic 回归模型的 AUC 为 0.84[95%CI=（0.77-0.92），p<0.001]。亚组分析显示，DNAR 状态仍然是年龄≥65 岁和≥80 岁的脓毒症患者死亡的独立预测因素。
在校正合并症、治疗和疾病严重程度后，DNAR 状态与脓毒症患者的院内死亡率相关。进一步的研究应评估医生对有 DNAR 状态的脓毒症患者的态度。
