Intensive Care Unit, Barwon Health, Geelong, Australia.
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.
Anaesth Intensive Care. 2021 May;49(3):173-182. doi: 10.1177/0310057X20978987. Epub 2021 Apr 14.
Self-harm is one of the most common reasons for admission to an intensive care unit (ICU). While most patients with self-harm survive the ICU admission, little is known about their outcomes after hospital discharge. We conducted a retrospective cohort study of patients in the Barwon region in Victoria admitted to the ICU with self-harm (between 1998 and 2018) who survived to hospital discharge. The primary objective was to determine mortality after hospital discharge, and secondarily estimate relative survival, years of potential life lost, cause of death and factors associated with death. Over the 20-year study period, there were 710 patients in the cohort. The median patient age was 37 years (interquartile range (IQR) 26-48 years). A total of 406 (57%) were female, and 527 (74%) had a prior psychiatric diagnosis. The incidence of ICU admission increased over time (incidence rate ratio 1.05; 95% confidence interval (CI) 1.03-1.06 per annum). There were 105 (15%) patients who died after hospital discharge. Relative survival decreased each year after discharge, with the greatest decrement during the first 12 months. At ten years, relative survival was 0.85 (95% CI 0.81-0.88). The median years of potential life lost was 35 (IQR 22-45). Cause of death was self-harm in 27%, possible self-harm in 32% and medical disease in 41%. The only factors associated with mortality were male sex, older age and re-admission to ICU with self-harm. Further population studies are required to confirm these findings, and to understand what interventions may improve long-term survival in this relatively young group of critically ill patients.
自残是重症监护病房（ICU）入院的最常见原因之一。虽然大多数自残患者在 ICU 入院后存活下来，但对他们出院后的结局知之甚少。我们对 1998 年至 2018 年间在维多利亚州巴旺地区因自残而入住 ICU 并存活至出院的患者进行了回顾性队列研究。主要目的是确定出院后的死亡率，并估计相对生存率、潜在生命损失年数、死亡原因和与死亡相关的因素。在 20 年的研究期间，该队列中有 710 名患者。患者的中位年龄为 37 岁（四分位距（IQR）26-48 岁）。共有 406 名（57%）为女性，527 名（74%）有既往精神科诊断。ICU 入院的发生率随时间增加（发病率比 1.05；95%置信区间（CI）每年 1.03-1.06）。出院后有 105 名（15%）患者死亡。出院后相对生存率每年下降，出院后前 12 个月下降幅度最大。十年时，相对生存率为 0.85（95%CI 0.81-0.88）。潜在生命损失的中位数为 35 年（IQR 22-45）。死亡原因是自残 27%、可能自残 32%和医学疾病 41%。唯一与死亡率相关的因素是男性、年龄较大和再次因自残入住 ICU。需要进一步的人群研究来证实这些发现，并了解哪些干预措施可能改善这一相对年轻的重症患者群体的长期生存率。
