Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
Thorax. 2019 Nov;74(11):1037-1045. doi: 10.1136/thoraxjnl-2018-213020. Epub 2019 Sep 3.
Long-term outcomes of critical illness may be affected by duration of critical illness and intensive care. We aimed to investigate differences in mortality and morbidity after short (<8 days) and prolonged (≥8 days) intensive care unit (ICU) stay.
Former EPaNIC-trial patients were included in this preplanned prospective cohort, 5-year follow-up study. Mortality was assessed in all. For morbidity analyses, all long-stay and-for feasibility-a random sample (30%) of short-stay survivors were contacted. Primary outcomes were total and post-28-day 5-year mortality. Secondary outcomes comprised handgrip strength (HGF, %pred), 6-minute-walking distance (6MWD, %pred) and SF-36 Physical Function score (PF SF-36). One-to-one propensity-score matching of short-stay and long-stay patients was performed for nutritional strategy, demographics, comorbidities, illness severity and admission diagnosis. Multivariable regression analyses were performed to explore ICU factors possibly explaining any post-ICU observed outcome differences.
After matching, total and post-28-day 5-year mortality were higher for long-stayers (48.2% (95%CI: 43.9% to 52.6%) and 40.8% (95%CI: 36.4% to 45.1%)) versus short-stayers (36.2% (95%CI: 32.4% to 40.0%) and 29.7% (95%CI: 26.0% to 33.5%), p<0.001). ICU risk factors comprised hypoglycaemia, use of corticosteroids, neuromuscular blocking agents, benzodiazepines, mechanical ventilation, new dialysis and the occurrence of new infection, whereas clonidine could be protective. Among 276 long-stay and 398 short-stay 5-year survivors, HGF, 6MWD and PF SF-36 were significantly lower in long-stayers (matched subset HGF: 83% (95%CI: 60% to 100%) versus 87% (95%CI: 73% to 103%), p=0.020; 6MWD: 85% (95%CI: 69% to 101%) versus 94% (95%CI: 76% to 105%), p=0.005; PF SF-36: 65 (95%CI: 35 to 90) versus 75 (95%CI: 55 to 90), p=0.002).
Longer duration of intensive care is associated with excess 5-year mortality and morbidity, partially explained by potentially modifiable ICU factors.
NCT00512122.
危重病的长期结局可能受危重病和重症监护时间的影响。我们旨在研究入住重症监护病房（ICU）时间较短（<8 天）和较长（≥8 天）的患者死亡率和发病率的差异。
本研究为 EPaNIC 试验的一项预设前瞻性队列、5 年随访研究，纳入了所有患者。评估所有患者的死亡率。对于发病率分析，联系了所有长期入住和为可行性而随机选择的（30%）短期入住幸存者。主要结局为总死亡率和 28 天后 5 年死亡率。次要结局包括握力（HGF，%预测值）、6 分钟步行距离（6MWD，%预测值）和 SF-36 生理功能评分（PF SF-36）。对短期和长期入住患者进行一对一倾向评分匹配，以比较营养策略、人口统计学、合并症、疾病严重程度和入院诊断。采用多变量回归分析探讨可能解释 ICU 后观察到的任何结局差异的 ICU 因素。
匹配后，长期入住患者的总死亡率和 28 天后 5 年死亡率更高（分别为 48.2%（95%CI：43.9%至 52.6%）和 40.8%（95%CI：36.4%至 45.1%）），而短期入住患者的死亡率分别为 36.2%（95%CI：32.4%至 40.0%）和 29.7%（95%CI：26.0%至 33.5%）（均 p<0.001）。ICU 危险因素包括低血糖、皮质激素、神经肌肉阻滞剂、苯二氮䓬类、机械通气、新透析和新发感染，而可乐定可能具有保护作用。在 276 名长期入住和 398 名短期入住的 5 年幸存者中，长期入住患者的 HGF、6MWD 和 PF SF-36 显著较低（匹配亚组 HGF：83%（95%CI：60%至 100%）与 87%（95%CI：73%至 103%），p=0.020；6MWD：85%（95%CI：69%至 101%）与 94%（95%CI：76%至 105%），p=0.005；PF SF-36：65（95%CI：35 至 90）与 75（95%CI：55 至 90），p=0.002）。
更长的 ICU 入住时间与 5 年超额死亡率和发病率相关，部分原因是潜在可改变的 ICU 因素。
NCT00512122。
