Kortelainen Simon, Curtze Sami, Martinez-Majander Nicolas, Raj Rahul, Skrifvars Markus B
Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2022 Apr;66(4):516-525. doi: 10.1111/aas.14037. Epub 2022 Feb 14.
Little is currently known about the cost-effectiveness of intensive care of acute ischemic stroke (AIS). We evaluated 1-year costs and outcome for patients with AIS treated in the intensive care unit (ICU).
A single-center retrospective study of patients admitted to an academic ICU with AIS between 2003 and 2013. True healthcare expenditure was obtained up to 1 year after admission and adjusted to consumer price index of 2019. Patient outcome was 12-month functional outcome and mortality. We used multivariate logistic regression analysis to identify independent predictors of favorable outcomes and linear regression analysis to assess factors associated with costs. We calculated the effective cost per survivor (ECPS) and effective cost per favorable outcome (ECPFO).
The study population comprised 154 patients. Reasons for ICU admission were: decreased consciousness level (47%) and need for respiratory support (40%). There were 68 (44%) 1 year survivors, of which 27 (18%) had a favorable outcome. High age (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91-0.98) and high hospital admission National Institutes of Health Stroke Scale score (OR 0.92, 95% CI 0.87-0.97) were independent predictors of poor outcomes. Increased age had a cost ratio of 0.98 (95% CI 0.97-0.99) per added year. The ECPS and ECPFO were 115,628€ and 291,210€, respectively.
Treatment of AIS in the ICU is resource-intense, and in an era predating mechanical thrombectomy the outcome is often poor, suggesting a need for further research into cost-efficacy of ICU care for AIS patients.
目前对于急性缺血性卒中（AIS）重症监护的成本效益了解甚少。我们评估了在重症监护病房（ICU）接受治疗的AIS患者的1年成本及预后。
对2003年至2013年间入住一所学术性ICU的AIS患者进行单中心回顾性研究。获取入院后长达1年的实际医疗支出，并根据2019年的消费物价指数进行调整。患者预后为12个月时的功能预后及死亡率。我们使用多变量逻辑回归分析来确定良好预后的独立预测因素，并使用线性回归分析来评估与成本相关的因素。我们计算了每存活一名患者的有效成本（ECPS）和每获得一个良好预后的有效成本（ECPFO）。
研究人群包括154例患者。入住ICU的原因有：意识水平下降（47%）和需要呼吸支持（40%）。有68例（44%）患者存活1年，其中27例（18%）预后良好。高龄（比值比[OR]0.95，95%置信区间[CI]0.91 - 0.98）和入院时较高的美国国立卫生研究院卒中量表评分（OR 0.92，95% CI 0.87 - 0.97）是预后不良的独立预测因素。年龄每增加一岁，成本比为0.98（95% CI 0.97 - 0.99）。ECPS和ECPFO分别为115,628欧元和291,210欧元。
在ICU中治疗AIS资源消耗大，并且在机械取栓术出现之前的时代，预后往往较差，这表明需要进一步研究AIS患者ICU护理的成本效益。
