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并发症和合并症对动脉瘤性蛛网膜下腔出血后重症监护住院时间的影响。

Impact of Complications and Comorbidities on the Intensive Care Length of Stay after Aneurysmal Subarachnoid Haemorrhage.

机构信息

Department of Neurosurgery, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany.

Department of Neurology, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany.

出版信息

Sci Rep. 2020 Apr 10;10(1):6228. doi: 10.1038/s41598-020-63298-9.

Abstract

In this observational study, we analysed a cohort of 164 subarachnoid haemorrhage survivors (until discharge from intensive care) with the aim to detect factors that influence the length of stay (LOS) in intensive care with multiple linear regression methods. Moreover, binary logistic regression methods were used to examine whether the time in intensive care is a predictor of outcome after 1 year. The clinical 1-year outcome was measured prospectively in a 12-month follow-up by telephone interview and categorised by the modified Rankin Scale (mRS). Patients who died during their stay in intensive care were excluded. Complications like pneumonia (β = 5.11; 95% CI = 1.75-8.46; p = 0.0031), sepsis (β = 9.54; 95% CI = 3.27-15.82; p = 0.0031), hydrocephalus (β = 4.63; 95% CI = 1.82-7.45; p = 0.0014), and delayed cerebral ischemia (DCI) (β = 3.38; 95% CI = 0.19-6.56; p = 0.038) were critical factors depending the LOS in intensive care as well as decompressive craniectomy (β = 5.02; 95% CI = 1.35-8.70; p = 0.0077). All analysed comorbidities such as hypertension, diabetes, hypothyroidism, cholesterinemia, and smoking history had no significant impact on the LOS in intensive care. LOS in intensive care (OR = 1.09; 95% CI = 1.03-1.15; p = 0.0023) as well as WFNS grade (OR = 3.72; 95% CI = 2.23-6.21; p < 0.0001) and age (OR = 1.06; 95% CI = 1.02-1.10; p = 0.0061) were significant factors that had an impact on the outcome after 1 year. Complications in intensive care but not comorbidities are associated with higher LOS in intensive care. LOS in intensive care is a modest but significant predictor of outcomes after subarachnoid haemorrhage.

摘要

在这项观察性研究中,我们分析了 164 例蛛网膜下腔出血幸存者(直至从重症监护病房出院)的队列,目的是使用多元线性回归方法检测影响重症监护住院时间(LOS)的因素。此外,还使用二项逻辑回归方法检查重症监护时间是否是 1 年后结局的预测因素。临床 1 年结局通过 12 个月的随访通过电话访谈进行前瞻性测量,并通过改良 Rankin 量表(mRS)进行分类。在重症监护期间死亡的患者被排除在外。肺炎(β=5.11;95%CI=1.75-8.46;p=0.0031)、败血症(β=9.54;95%CI=3.27-15.82;p=0.0031)、脑积水(β=4.63;95%CI=1.82-7.45;p=0.0014)和迟发性脑缺血(DCI)(β=3.38;95%CI=0.19-6.56;p=0.038)等并发症是影响重症监护 LOS 的关键因素,去骨瓣减压术(β=5.02;95%CI=1.35-8.70;p=0.0077)也是如此。所有分析的合并症,如高血压、糖尿病、甲状腺功能减退、胆固醇血症和吸烟史,对重症监护住院时间均无显著影响。重症监护住院时间(OR=1.09;95%CI=1.03-1.15;p=0.0023)以及 WFNS 分级(OR=3.72;95%CI=2.23-6.21;p<0.0001)和年龄(OR=1.06;95%CI=1.02-1.10;p=0.0061)是影响 1 年后结局的显著因素。重症监护中的并发症而不是合并症与重症监护住院时间较长有关。重症监护住院时间是蛛网膜下腔出血后结局的适度但重要的预测因素。

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