波兰某一地理区域的综合 ICU 再入院率似乎与更好的预后相关。

Readmissions to General ICUs in a Geographic Area of Poland Are Seemingly Associated with Better Outcomes.

机构信息

Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, 41-800 Zabrze, Poland.

Department of Science, Education and New Medical Technologies, Silesian Centre for Heart Diseases, 41-800 Zabrze, Poland.

出版信息

Int J Environ Res Public Health. 2020 Jan 16;17(2):565. doi: 10.3390/ijerph17020565.

DOI:10.3390/ijerph17020565

PMID:31963101

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7014014/

Abstract

BACKGROUND

Various factors can contribute to high mortality rates in intensive care units (ICUs). Here, we intended to define a population of patients readmitted to general ICUs in Poland and to identify independent predictors of ICU readmission.

METHODS

Data derived from adult ICU admissions from the Silesian region of Poland were analyzed. First-time ICU readmissions (≤30 days from ICU discharge after index admissions) were compared with first-time ICU admissions. Pre-admission and admission variables that independently influenced the need for ICU readmission were identified.

RESULTS

Among the 21,495 ICU admissions, 839 were first-time readmissions (3.9%). Patients readmitted to the ICU had lower mean APACHE II (21.2 ± 8.0 vs. 23.2 ± 8.8, < 0.001) and TISS-28 scores (33.7 ± 7.4 vs. 35.2 ± 7.8, < 0.001) in the initial 24 h following ICU admission, compared to first-time admissions. ICU readmissions were associated with lower mortality vs. first-time admissions (39.2% vs. 44.3%, = 0.004). Independent predictors for ICU readmission included the admission from a surgical ward (among admission sources), chronic respiratory failure, cachexia, previous stroke, chronic neurological diseases (among co-morbidities), and multiple trauma or infection (among primary reasons for ICU admission).

CONCLUSIONS

High mortality associated with first-time ICU admissions is associated with a lower mortality rate during ICU readmissions.

摘要

背景

多种因素可导致重症监护病房（ICU）的死亡率居高不下。在这里，我们旨在确定波兰普通 ICU 再次入院的患者人群，并确定 ICU 再次入院的独立预测因素。

方法

分析了来自波兰西里西亚地区成人 ICU 入院的数据。将首次 ICU 再入院（从首次 ICU 出院后 30 天内）与首次 ICU 入院进行比较。确定了独立影响 ICU 再入院需求的入院前和入院变量。

结果

在 21495 例 ICU 入院中，有 839 例是首次再入院（3.9%）。与首次入院相比，再次入 ICU 的患者 ICU 入住初始 24 小时内的平均急性生理与慢性健康评分 II（APACHE II）（21.2 ± 8.0 与 23.2 ± 8.8，<0.001）和简化急性生理评分 II（TISS-28）评分（33.7 ± 7.4 与 35.2 ± 7.8，<0.001）较低。与首次入院相比，ICU 再入院的死亡率较低（39.2% 与 44.3%，= 0.004）。ICU 再入院的独立预测因素包括从外科病房（在入院来源中）入院、慢性呼吸衰竭、恶病质、既往中风、慢性神经疾病（在合并症中）以及多发创伤或感染（在 ICU 入院的主要原因中）。