Kim Hye-Bin, Na Sungwon, Paik Hyo Chae, Joo Hyeji, Kim Jeongmin
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
Acute Crit Care. 2021 May;36(2):99-108. doi: 10.4266/acc.2020.01144. Epub 2021 Apr 5.
Lung transplantation (LT) is an accepted therapeutic modality for end-stage lung disease patients. Intensive care unit (ICU) readmission is a risk factor for mortality after LT, for which consistent risk factors have not been elucidated. Thus, we investigated the risk factors for ICU readmission during index hospitalization after LT, particularly regarding the posttransplant condition of LT patients.
In this retrospective study, we investigated all adult patients undergoing LT between October 2012 and August 2017 at our institution. We collected perioperative data from electronic medical records such as demographics, comorbidities, laboratory findings, ICU readmission, and in-hospital mortality.
We analyzed data for 130 patients. Thirty-two patients (24.6%) were readmitted to the ICU 47 times during index hospitalization. At the initial ICU discharge, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR], 1.464; 95% confidence interval [CI], 1.083-1.978; P=0.013) and pH (OR, 0.884; 95% CI, 0.813-0.962; P=0.004; when the pH value increases by 0.01) were related to ICU readmission using multivariable regression analysis and were still significant after adjusting for confounding factors. Thirteen patients (10%) died during the hospitalization period, and the number of ICU readmissions was a significant risk factor for in-hospital mortality. The most common causes of ICU readmission and in-hospital mortality were infection-related.
The SOFA score and pH were associated with increased risk of ICU readmission. Early postoperative management of these factors and thorough posttransplantation infection control can reduce ICU readmission and improve the prognosis of LT patients.
肺移植（LT）是终末期肺病患者公认的治疗方式。重症监护病房（ICU）再入院是肺移植后死亡的一个危险因素，目前尚未阐明其一致的危险因素。因此，我们调查了肺移植后首次住院期间ICU再入院的危险因素，尤其关注肺移植患者的移植后状况。
在这项回顾性研究中，我们调查了2012年10月至2017年8月在我院接受肺移植的所有成年患者。我们从电子病历中收集围手术期数据，如人口统计学资料、合并症、实验室检查结果、ICU再入院情况和住院死亡率。
我们分析了130例患者的数据。32例患者（24.6%）在首次住院期间47次被再次收入ICU。在首次ICU出院时，序贯器官衰竭评估（SOFA）评分（比值比[OR]，1.464；95%置信区间[CI]，1.083 - 1.978；P = 0.013）和pH值（OR，0.884；95%CI，0.813 - 0.962；P = 0.004；pH值每增加0.01）通过多变量回归分析与ICU再入院相关，在调整混杂因素后仍具有显著性。13例患者（10%）在住院期间死亡，ICU再入院次数是住院死亡率的一个显著危险因素。ICU再入院和住院死亡的最常见原因与感染相关。
SOFA评分和pH值与ICU再入院风险增加相关。对这些因素进行术后早期管理以及全面的移植后感染控制可降低ICU再入院率并改善肺移植患者的预后。
