Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Department of Anesthesia, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON, M5G 1E2, Canada.
Intensive Care Med. 2019 Nov;45(11):1550-1558. doi: 10.1007/s00134-019-05752-5. Epub 2019 Sep 3.
Survivors of critical illness may be at higher risk of developing subsequent mental illness. We sought to determine the risk of new mental illness diagnoses across a large population of intensive care unit (ICU) survivors compared with hospitalized patients.
Population-based study (2005-2015) conducted in adults hospitalized in Ontario, Canada. The primary exposure was ICU admission for ≥ 48 h; secondary exposures were ICU procedures including mechanical ventilation and duration of ICU. The primary outcome was mental illness diagnosed during the year after hospital discharge. To account for case mix differences between ICU and other hospitalized patients, sensitivity analyses were conducted restricting to six pre-specified diagnoses that can lead to hospitalization with or without ICU.
1,847,462 patients survived hospitalization, of whom 121,101 were admitted to ICU for ≥ 48 h. ICU patients had a higher rate of new mental illness diagnoses in the year after discharge compared to hospitalized patients (17 vs. 15%, adjusted hazard ratio (aHR) 1.08, 95% CI 1.07-1.10). In analyses restricted to pre-specified most responsible diagnoses, the increased risk associated with ICU was only significant for patients with pneumonia. Among ICU survivors, exposure to mechanical ventilation (aHR: 1.08; 95% CI 1.05-1.12) or longer ICU stays (aHR: 1.004 per day; 95% CI 1.003-1.005) increased the risk of new mental illness diagnosis.
ICU was associated with a marginally increased risk of mental illness diagnosis after hospitalization that was often no longer apparent when reason for admission was considered. Patients exposed to mechanical ventilation or longer ICU stays may be at higher risk of subsequent mental illnesses.
危重病幸存者可能面临更高的罹患后续精神疾病的风险。我们旨在确定与住院患者相比，大量 ICU 幸存者罹患新的精神疾病诊断的风险。
这是一项在加拿大安大略省住院成人中开展的基于人群的研究（2005-2015 年）。主要暴露因素为 ICU 入住时长≥48 小时；次要暴露因素包括 ICU 操作，如机械通气和 ICU 时长。主要结局为出院后 1 年内诊断出的精神疾病。为了说明 ICU 患者与其他住院患者之间病例组合的差异，进行了敏感性分析，将分析限制在 6 种可导致住院治疗（无论是否 ICU 治疗）的特定诊断上。
1847462 名患者存活出院，其中 121101 名患者因 ICU 入住时长≥48 小时而入住 ICU。与住院患者相比，ICU 患者出院后 1 年内新诊断出精神疾病的比例更高（17%比 15%，调整后的危险比[aHR]为 1.08，95%置信区间[CI]为 1.07-1.10）。在限制于特定最主要诊断的分析中，与 ICU 相关的风险增加仅在患有肺炎的患者中具有统计学意义。在 ICU 幸存者中，机械通气暴露（aHR：1.08；95%CI 1.05-1.12）或 ICU 入住时间延长（aHR：每天增加 0.004；95%CI 1.003-1.005）均会增加新的精神疾病诊断风险。
住院后 ICU 与精神疾病诊断风险略有增加相关，而当考虑入院原因时，这种相关性通常不再明显。暴露于机械通气或 ICU 入住时间延长的患者可能面临更高的后续精神疾病风险。
