Chen Fei, Li Yi-Ming, Liu Qi, Huang Bao-Tao, Huang Fang-Yang, Peng Yong, Chen Mao
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
J Geriatr Cardiol. 2021 Feb 28;18(2):94-103. doi: 10.11909/j.issn.1671-5411.2021.02.005.
Few studies from developed countries have quantitatively characterized the clinical characteristics and outcomes of patients receiving contemporary intensive cardiac care. We sought to investigate these data in patients admitted to a Chinese intensive cardiac care unit (ICCU).
We conducted a retrospective study using data from 2,337 consecutive admissions to the ICCU at a large centre in China from June 2016 to May 2017. Data were captured after systematic inspection of individual medical records regarding current demographics, primary diagnosis, comorbidities, illnesses severity, and in-hospital outcomes.
The mean age was 65.6 ± 14.2 years, and females accounted for 32.0% of patients. The Charlson Comorbidity Index and Oxford Acute Severity of Illness Score were 2.4 ± 1.8 and 22.5 ± 10.4, respectively. The top reason for admission was ST-segment elevation myocardial infarction (32.0%), and nonischaemic heart diseases accounted for 31.2% of all primary diagnoses. Noncardiovascular diseases were prevalent in the ICCU population, including chronic illnesses and acute noncardiovascular critical illnesses (ANCIs); in particular, 21.7% of patients were marked by acute respiratory failure (14.6%), acute kidney injury (13.7%), sepsis (4.2%), or gastrointestinal bleeding (3.3%). The median length of stay in the ICCU and hospital were 1.1 days [interquartile range (IQR): 0.8-2.6 days] and 6.3 days (IQR: 3.8-10.9 days), respectively. The overall incidence of in-hospital death or discharge against medical advice under extremely critical conditions was 7.6% ( = 177). Multivariate logistic regression analysis showed that the complexity of chronic illnesses and incident ANCIs were strong independent determinants for in-hospital outcomes.
Remarkable patient diversity and breadth of critical illnesses were observed in a Chinese ICCU population. Particularly, noncardiovascular diseases were prevalent and associated with adverse outcomes. Reformation of organization and staffing practices may be considered to adapt to the changed landscape.
发达国家很少有研究对接受当代强化心脏护理的患者的临床特征和预后进行定量描述。我们试图在中国一家强化心脏护理病房（ICCU）收治的患者中调查这些数据。
我们进行了一项回顾性研究，使用了2016年6月至2017年5月期间中国一家大型中心ICCU连续收治的2337例患者的数据。在系统检查个体病历中的当前人口统计学、初步诊断、合并症、疾病严重程度和住院结局后收集数据。
平均年龄为65.6±14.2岁，女性占患者的32.0%。Charlson合并症指数和牛津急性疾病严重程度评分分别为2.4±1.8和22.5±10.4。入院的首要原因是ST段抬高型心肌梗死（32.0%），非缺血性心脏病占所有初步诊断的31.2%。非心血管疾病在ICCU人群中普遍存在，包括慢性疾病和急性非心血管危重症（ANCIs）；特别是，21.7%的患者表现为急性呼吸衰竭（14.6%）、急性肾损伤（13.7%）、脓毒症（4.2%）或胃肠道出血（3.3%）。在ICCU的中位住院时间和住院总时间分别为1.1天[四分位间距（IQR）：0.8 - 2.6天]和6.3天（IQR：3.8 - 10.9天）。在极端危急情况下，住院死亡或违背医疗建议出院的总体发生率为7.6%（=177）。多因素逻辑回归分析表明，慢性疾病的复杂性和发生的ANCIs是住院结局的强有力独立决定因素。
在中国ICCU人群中观察到了显著的患者多样性和危重症范围。特别是，非心血管疾病普遍存在且与不良结局相关。可能需要考虑对组织和人员配置实践进行改革，以适应变化了的情况。
