Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France.
Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France; ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (center of epidemiology and biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris, France.
J Crit Care. 2021 Feb;61:82-88. doi: 10.1016/j.jcrc.2020.10.008. Epub 2020 Oct 15.
Prognostic impact of early ICU admission remains controversial. The aim of this review was to investigate the impact of early ICU admission in the general ICU population and in critically ill cancer patients and to report level of evidences of this later.
Systematic review and meta-analysis performed on articles published between 1970 and 2017. Two authors extracted data. Influence of early ICU admission on mortality is reported as Risk Ratio (95%CI) using both fixed and random-effects model.
For general ICU population, 31 studies reporting on 73,213 patients were included (including 66,797 patients with early ICU admission) and for critically ill cancer patients 14 studies reporting on 2414 patients (including 1272 with early ICU admission) were included. Early ICU admission was associated with decreased mortality using a random effect model (RR 0.65; 95% confidence interval 0.58-0.73; I = 66%) in overall ICU population as in critically ill cancer patients (RR 0.69; 95% confidence interval 0.52-0.90; I = 85%). To explore heterogeneity, a meta-regression was performed. Characteristics of the trials (prospective vs. retrospective, monocenter vs. multicenter) had no impact on findings. Publication after 2010 (median publication period) was associated with a lower effect of early ICU admission (estimate 0.37; 95%CI 0.14-0.60; P = 0.002) in the general ICU population. A significant publication bias was observed.
Theses results suggest that early ICU admission is associated with decreased mortality in the general ICU population and in CICP. These results were however obtained from high risk of bias studies and a high heterogeneity was noted. Systematic review registration: PROSPERO 2018 CRD42018094828.
早期 ICU 入住对预后的影响仍存在争议。本研究旨在调查 ICU 普通患者和危重症癌症患者中早期 ICU 入住的影响，并报告后者的证据水平。
对 1970 年至 2017 年期间发表的文章进行系统回顾和荟萃分析。两位作者提取数据。使用固定和随机效应模型报告早期 ICU 入住对死亡率的影响，结果表示为风险比（95%CI）。
纳入 ICU 普通患者的 31 项研究，共纳入 73213 例患者（包括 66797 例早期 ICU 入住患者），纳入危重症癌症患者的 14 项研究，共纳入 2414 例患者（包括 1272 例早期 ICU 入住患者）。使用随机效应模型，早期 ICU 入住与 ICU 普通患者和危重症癌症患者死亡率降低相关（RR 0.65；95%置信区间 0.58-0.73；I=66%；RR 0.69；95%置信区间 0.52-0.90；I=85%）。为了探讨异质性，进行了 meta 回归分析。试验特征（前瞻性与回顾性、单中心与多中心）对结果无影响。2010 年后发表（中位发表时间）与 ICU 普通患者早期 ICU 入住效果降低相关（估计值 0.37；95%CI 0.14-0.60；P=0.002）。观察到显著的发表偏倚。
这些结果表明，早期 ICU 入住与 ICU 普通患者和 CICP 患者死亡率降低相关。然而，这些结果是从高偏倚风险的研究中获得的，并且存在高度异质性。系统评价注册：PROSPERO 2018 CRD42018094828。
