Department of Medicine, 311816University of Minnesota Medical School, Minneapolis, MN, USA.
School of Public Health, 311816University of Minnesota, Minneapolis, MN, USA.
J Intensive Care Med. 2022 Feb;37(2):185-194. doi: 10.1177/0885066620982905. Epub 2020 Dec 23.
With decades of declining ICU mortality, we hypothesized that the outcomes and distribution of diseases cared for in the ICU have changed and we aimed to further characterize them.
A retrospective cohort analysis of 287,154 nonsurgical-critically ill adults, from 237 U.S. ICUs, using the manually abstracted Cerner APACHE Outcomes database from 2008 to 2016 was performed. Surgical patients, rare admission diagnoses (<100 occurrences), and low volume hospitals (<100 total admissions) were excluded. Diagnoses were distributed into mutually exclusive organ system/disease-based categories based on admission diagnosis. Multi-level mixed-effects negative binomial regression was used to assess temporal trends in admission, in-hospital mortality, and length of stay (LOS).
The number of ICU admissions remained unchanged (IRR 0.99, 0.98-1.003) while certain organ system/disease groups increased (toxicology [25%], hematologic/oncologic [55%] while others decreased (gastrointestinal [31%], pulmonary [24%]). Overall risk-adjusted in-hospital mortality was unchanged (IRR 0.98, 0.96-1.0004). Risk-adjusted ICU LOS (Estimate -0.06 days/year, -0.07 to -0.04) decreased. Risk-adjusted mortality varied significantly by disease.
Risk-adjusted ICU mortality rate did not change over the study period, but there was evidence of shifting disease burden across the critical care population. Our data provides useful information regarding future ICU personnel and resource needs.
经过几十年 ICU 死亡率的下降，我们假设 ICU 收治的疾病的结局和分布已经发生了变化，我们旨在进一步对其进行描述。
对来自美国 237 家 ICU 的 287154 名非外科危重症成年人进行回顾性队列分析，使用 2008 年至 2016 年从 Cerner APACHE Outcomes 数据库手动提取的资料。排除外科患者、罕见入院诊断（<100 例）和低容量医院（<100 例总入院人数）。根据入院诊断，将诊断分布到相互排斥的器官系统/疾病为基础的类别中。采用多水平混合效应负二项回归分析评估入院、院内死亡率和住院时间（LOS）的时间趋势。
ICU 入院人数保持不变（IRR 0.99，0.98-1.003），而某些器官系统/疾病组增加（毒理学[25%]，血液/肿瘤学[55%]，而其他组减少（胃肠道[31%]，肺部[24%]）。总体风险调整后的院内死亡率保持不变（IRR 0.98，0.96-1.0004）。风险调整后的 ICU LOS（估计值-0.06 天/年，-0.07 至-0.04）下降。风险调整后的死亡率因疾病而异。
在研究期间，风险调整后的 ICU 死亡率没有变化，但有证据表明重症监护人群中的疾病负担发生了转移。我们的数据提供了有关未来 ICU 人员和资源需求的有用信息。
