Shaw Martin, Viglianti Elizabeth M, McPeake Joanne, Bagshaw Sean M, Pilcher David, Bellomo Rinaldo, Iwashyna Theodore J, Quasim Tara
NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom.
Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI.
Crit Care Explor. 2020 Apr 29;2(4):e0102. doi: 10.1097/CCE.0000000000000102. eCollection 2020 Apr.
We aimed to understand the prevalence, timing of onset, resource use, and long-term outcomes of patients who developed persistent critical illness in a national dataset.
Retrospective cohort. Using a physiologic risk adjustment model from ICU admission, we examined the relative ability of acute (related to reason for ICU presentation) and antecedent (demographics, comorbidities) characteristics to discriminate hospital mortality models. Persistent critical illness was defined as the point during an ICU stay when, at the population-level, patients' acute diagnoses and physiologic disturbance are no longer more accurate at discriminating who survives than are baseline demographics and comorbidity. We examined the change across ICU stay in the relative discrimination of those characteristics, and short-term (in-hospital and 30 d after admission) and medium-term (90 d after admission) survival. Finally, we analyzed the changes in the population definition of persistent critical illness over time.
Patients admitted as level 3 to Scottish ICUs between 2005 and 2014.
Seventy-two-thousand two-hundred fifty-three adult level 3 ICU admissions in 23 ICUs across Scotland.
None.
The onset of persistent critical illness, occurs at an average of 5.0 days (95% CI, 3.9-6.4 d) across this dataset. The crossing point increased across the decade, by an average of 0.36 days (95% CI, 0.22-0.50 d) per year. In this dataset, 24,425 (33.8%) remained in the ICU long enough to meet this greater than 5-day definition of persistent critical illness. The care of such patients involved 72.3% ICU days used by any level 3 patient; 46.5% of all Scottish ICU bed-days were after day 5. Although rates of 30 days after admission survival rose dramatically during the decade under study, these rates were similar for those with shorter or longer ICU stays, as were the rates of 90-day survival among those who survived at least 30 days.
Persistent critical illness occurred in one in three ICU patients in Scotland. These minority of patients accounted for disproportionate hospital resources but did not have worse 30- or 90-day postadmission survival.
我们旨在了解在一个全国性数据集中发生持续性危重病的患者的患病率、发病时间、资源利用情况和长期预后。
回顾性队列研究。使用来自重症监护病房（ICU）入院时的生理风险调整模型，我们研究了急性（与入住ICU的原因相关）和既往（人口统计学、合并症）特征在区分医院死亡模型方面的相对能力。持续性危重病定义为在ICU住院期间的某个时间点，在总体水平上，患者的急性诊断和生理紊乱在区分存活者方面不再比基线人口统计学和合并症更准确。我们研究了这些特征在ICU住院期间相对区分能力的变化，以及短期（住院期间和入院后30天）和中期（入院后90天）的生存率。最后，我们分析了持续性危重病的总体定义随时间的变化。
2005年至2014年期间入住苏格兰三级ICU的患者。
苏格兰23个ICU的72253例成人三级ICU入院患者。
无。
在这个数据集中，持续性危重病的发病平均发生在5.0天（95%可信区间，3.9 - 6.4天）。在这十年中，交叉点逐年增加，平均每年增加0.36天（95%可信区间，0.22 - 0.50天）。在这个数据集中，24,425例（33.8%）患者在ICU停留时间足够长，符合这种超过5天的持续性危重病定义。这类患者的护理占用了任何三级患者72.3%的ICU住院天数；所有苏格兰ICU床位天数的46.5%是在第5天之后。尽管在研究的十年中，入院后30天的生存率显著上升，但对于ICU住院时间较短或较长的患者，这些生存率相似，对于至少存活30天的患者，90天生存率也相似。
在苏格兰，三分之一的ICU患者发生了持续性危重病。这些少数患者占用了不成比例的医院资源，但入院后30天或90天的生存率并不更差。
