透析依赖的慢性肾脏病需重症监护患者的长期预后：一项观察性匹配队列研究。

Long-term outcomes of dialysis-dependent chronic kidney disease patients requiring critical care: an observational matched cohort study.

机构信息

Department of Intensive Care, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.

School of Medicine, Flinders University, Adelaide, South Australia, Australia.

出版信息

Intern Med J. 2021 Apr;51(4):548-556. doi: 10.1111/imj.14764.

DOI:10.1111/imj.14764

PMID:31990145

Abstract

BACKGROUND

The prevalence of dialysis-dependent chronic kidney disease (CKD5D) patients in Australia is increasing.

AIMS

To describe the long-term outcome and resource utilisation of CKD5D patients requiring critical care admission.

METHODS

Retrospective matched cohort study conducted in the intensive care unit (ICU) of Alice Springs Hospital. CKD5D patients admitted between 1 January 2011 and 31 December 2013 were matched by sex, age, Indigenous status and APACHE III score in a 1:1 ratio with a patient without CKD5D. Primary outcome was mortality censored at 31 December 2018, to allow a minimum 5-year follow up. Secondary outcomes explored resource use including ICU and hospital length of stay (LoS).

RESULTS

During the study period, 178 (9%) admissions were coded as having CKD5D, 148 (83%) of which were successfully matched. CKD5D patients were older (52 vs 49 years, P < 0.01), with more chronic cardiovascular disease (34 vs 23%, P < 0.01). Five-year mortality was similar (49.5 vs 41.5%, P = 0.28), with a significantly longer time to death in the CKD5D cohort (1179 vs 341 days, P < 0.01). CKD5D patients had a shorter median ICU LoS (1.9 vs 3.0 days, P < 0.01) and lower rates of mechanical ventilation (12.2 vs 35.4%, P < 0.01).

CONCLUSION

CKD5D patients frequently require intensive care during acute illness. While they have an equivalent 5-year survival rate, time to death is longer suggesting mortality is related to chronic disease progression rather than their acute illness. These results suggest the presence of CKD5D in isolation should not be a reason to limit critical care.

摘要

背景

澳大利亚依赖透析的慢性肾脏病（CKD5D）患者的患病率正在增加。

目的

描述需要重症监护入院的 CKD5D 患者的长期结局和资源利用情况。

方法

这是在爱丽丝泉医院重症监护病房（ICU）进行的回顾性匹配队列研究。2011 年 1 月 1 日至 2013 年 12 月 31 日期间，将 CKD5D 患者按性别、年龄、土著身份和急性生理学和慢性健康评估 III 评分（APACHE III 评分）进行 1:1 匹配，与没有 CKD5D 的患者进行匹配。主要结局是截止到 2018 年 12 月 31 日的死亡率，以允许至少 5 年的随访。探索次要结局包括 ICU 和住院时间（LoS）。

结果

在研究期间，178 次（9%）入院被编码为 CKD5D，其中 148 次（83%）成功匹配。CKD5D 患者年龄较大（52 岁比 49 岁，P <0.01），且更多患有慢性心血管疾病（34%比 23%，P <0.01）。5 年死亡率相似（49.5%比 41.5%，P =0.28），但 CKD5D 队列的死亡时间明显更长（1179 天比 341 天，P <0.01）。CKD5D 患者 ICU 中位 LOS 较短（1.9 天比 3.0 天，P <0.01），机械通气率较低（12.2%比 35.4%，P <0.01）。