Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
PLoS One. 2021 Apr 8;16(4):e0249840. doi: 10.1371/journal.pone.0249840. eCollection 2021.
Although critical illness is usually of high acuity and short duration, some patients require prolonged management in intensive care units (ICU) and suffer long-term morbidity and mortality.
To describe the long-term survival and examine determinants of death among patients with prolonged ICU admission.
A retrospective cohort of adult Queensland residents admitted to ICUs for 14 days or longer in North Brisbane, Australia was assembled. Comorbid illnesses were classified using the Charlson definitions and all cause case fatality established using statewide vital statistics.
During the study a total of 28,742 adult Queensland residents had first admissions to participating ICUs of which 1,157 (4.0%) had prolonged admissions for two weeks or longer. Patients with prolonged admissions included 645 (55.8%), 243 (21.0%), and 269 (23.3%) with ICU lengths of stay lasting 14-20, 21-27, and ≥28 days, respectively. Although the severity of illness at admission did not vary, pre-existing comorbid illnesses including myocardial infarction, congestive heart failure, kidney disease, and peptic ulcer disease were more frequent whereas cancer, cerebrovascular accidents, and plegia were less frequently observed among patients with increasing ICU lengths of stay lasting 14-20, 21-27, and ≥28 days. The ICU, hospital, 90-day, and one-year all cause case-fatality rates were 12.7%, 18.5%, 20.2%, and 24.9%, respectively, and were not different according to duration of ICU stay. The median duration of observation was 1,037 (interquartile range, 214-1888) days. Although comorbidity, age, and admitting diagnosis were significant, neither ICU duration of stay nor severity of illness at admission were associated with overall survival outcome in a multivariable Cox regression model.
Most patients with prolonged stays in our ICUs are alive at one year post-admission. Older age and previous comorbidities, but not severity of illness or duration of ICU stay, are associated with adverse long-term mortality outcome.
尽管危重病通常具有高的急性和短暂的持续时间，但一些患者需要在重症监护病房（ICU）进行长期管理，并遭受长期的发病率和死亡率。
描述长期存活并检查 ICU 住院时间延长患者的死亡决定因素。
在澳大利亚北布里斯班的 ICU 住院 14 天或以上的昆士兰州成年居民中组建了一个回顾性队列。使用 Charlson 定义对合并症进行分类，并使用全州生命统计数据确定所有原因病死率。
在研究期间，共有 28742 名昆士兰州成年居民首次入住参与 ICU，其中 1157 名（4.0%）的住院时间延长两周或更长。延长入住的患者包括分别持续 ICU 入住 14-20、21-27 和≥28 天的 645 名（55.8%）、243 名（21.0%）和 269 名（23.3%）。尽管入院时的疾病严重程度没有差异，但存在更多的预先存在的合并症，包括心肌梗死、充血性心力衰竭、肾脏疾病和消化性溃疡病，而癌症、脑血管意外和麻痹在 ICU 入住 14-20、21-27 和≥28 天的患者中较少观察到。ICU、医院、90 天和一年的全因病死率分别为 12.7%、18.5%、20.2%和 24.9%，且根据 ICU 住院时间长短而无差异。中位观察期为 1037 天（四分位距，214-1888 天）。尽管合并症、年龄和入院诊断是显著的，但在多变量 Cox 回归模型中，ICU 住院时间长短或入院时的疾病严重程度均与总体生存结果无关。
我们 ICU 中大多数延长住院时间的患者在入院后一年仍存活。年龄较大和以前的合并症，但不是疾病的严重程度或 ICU 住院时间长短，与不良的长期死亡率结局相关。
