University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK.
University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK.
Br J Anaesth. 2021 Feb;126(2):415-422. doi: 10.1016/j.bja.2020.09.035. Epub 2020 Oct 31.
Polypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness.
A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay.
Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001).
This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.
多种药物治疗在重症患者中很常见，且与药物相互作用密切相关。在应激能力降低的重症患者存活者中，多种药物治疗的影响尚未得到量化。我们的目的是确定与入院前多种药物治疗相关的因素，并确定多种药物治疗是否是从重症监护病房出院后紧急再次入院的独立危险因素。
这是一项基于人群的队列研究，纳入了 2011 年 1 月 1 日至 2013 年 12 月 31 日期间入住苏格兰所有普通 ICU 的患者，这些患者存活了下来。根据是否存在入院前多种药物治疗（定义为开了五种或更多常规药物）对患者进行分层。主要结局是从指数住院治疗出院后 1 年内紧急再次入院。
在 23844 名 ICU 患者中，有 29.9%（7138 名）被确定为多种药物治疗。与多种药物治疗相关的因素包括女性、年龄增加和社会剥夺。在多种药物治疗组中，1 年时紧急再次入院的比例显著更高（51.8% vs 35.8%，P<0.001）。在调整混杂因素后，多种药物治疗的患者 1 年时紧急再次入院的风险增加了 22%（调整后的危险比 1.22，95%置信区间 1.16-1.28，P<0.001）。在多种药物治疗的线性范围内，每增加一种药物，1 年内紧急再次入院的风险增加 3%（调整后的危险比 1.03，95%置信区间 1.02-1.03，P<0.001）。
这项 ICU 存活者的全国性队列研究表明，入院前多种药物治疗是紧急再次入院的独立危险因素。在药物治疗日益增多的时代，这一危险因素可能代表着高危重症监护后人群的巨大负担。
