Hiraoka Eiji, Arai Junya, Kojima Shunsuke, Norisue Yasuhiro, Suzuki Toshihiko, Homma Yosuke, Takahashi Osamu, Obunai Kotaro, Watanabe Hiroyuki
Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Chiba 279-0001, Japan.
Department of Critical Care and Pulmonary Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Chiba 279-0001, Japan.
Int J Gen Med. 2020 Sep 28;13:721-728. doi: 10.2147/IJGM.S252651. eCollection 2020.
An early do-not-resuscitate (DNR) order is classified as such when it occurs within 24 hours of admission. Early DNR has been previously associated with in-hospital mortality among acute heart failure (AHF) patients and one-year mortality among patients discharged from ICU. Here, we investigate whether early DNR is associated with long-term mortality in AHF Japanese patients, by performing a retrospective cohort study.
We retrospectively investigated all patients with AHF, admitted to our hospital between April 2013 and March 2015, and survived to discharge. We obtained data on demographics, comorbidities, laboratory and echocardiography results, social background, DNR status, and outcomes (one-year death). The association of early DNR with one-year death was analyzed by multivariate logistic regression analysis.
Among 370 survive to discharge patients, 48 (12%) were lost to follow up. We analyzed 322 patients. The median age was 74 years, and 80 (25%) had an early DNR order. Patients with a DNR order were older and displayed more activities of daily living (ADL)-dependence. Early DNR was associated with higher one-year mortality.
Early DNR was associated with one-year mortality among AHF patients. Further studies are necessary to investigate unmeasured factors associated with a worse prognosis related to early DNR among AHF patients.
入院后24小时内下达的早期不进行心肺复苏（DNR）医嘱即被归类为早期DNR。早期DNR此前已被证明与急性心力衰竭（AHF）患者的院内死亡率以及从重症监护病房（ICU）出院患者的一年死亡率相关。在此，我们通过进行一项回顾性队列研究，调查早期DNR是否与日本AHF患者的长期死亡率相关。
我们回顾性调查了2013年4月至2015年3月期间入住我院且存活至出院的所有AHF患者。我们获取了有关人口统计学、合并症、实验室及超声心动图检查结果、社会背景、DNR状态及转归（一年死亡情况）的数据。通过多因素逻辑回归分析来分析早期DNR与一年死亡之间的关联。
在370例存活至出院的患者中，48例（12%）失访。我们对322例患者进行了分析。中位年龄为74岁，其中80例（25%）有早期DNR医嘱。有DNR医嘱的患者年龄更大，且日常生活活动（ADL）依赖程度更高。早期DNR与更高的一年死亡率相关。
早期DNR与AHF患者的一年死亡率相关。有必要进一步开展研究，以调查AHF患者中与早期DNR相关的预后较差的未测量因素。
