亚洲 9 国 317 家 ICU 患者 18 年死亡率的危险因素：医源性感染的影响。
Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections.
机构信息
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States.
International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, United States.
出版信息
Infect Control Hosp Epidemiol. 2023 Aug;44(8):1261-1266. doi: 10.1017/ice.2022.245. Epub 2022 Oct 24.
OBJECTIVE
To identify risk factors for mortality in intensive care units (ICUs) in Asia.
DESIGN
Prospective cohort study.
SETTING
The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam.
PARTICIPANTS
Patients aged >18 years admitted to ICUs.
RESULTS
In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line-associated bloodstream infection (CLABSI; aOR, 2.36; < .0001), ventilator-associated event (VAE; aOR, 1.51; < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; < .0001), and female sex (aOR, 1.06; < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; < .0001), upper middle-income country (aOR, 1.09; = .033), surgical hospitalization (aOR, 2.17; < .0001), pediatric oncology ICU (aOR, 9.90; < .0001), and adult oncology ICU (aOR, 4.52; < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; < .0001).
CONCLUSIONS
Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.
目的
确定亚洲重症监护病房（ICU）患者死亡的危险因素。
设计
前瞻性队列研究。
地点
该研究纳入了亚洲 9 个国家 44 个城市的 96 家医院的 317 个 ICU：中国、印度、马来西亚、蒙古、尼泊尔、巴基斯坦、菲律宾、斯里兰卡、泰国和越南。
研究对象
入住 ICU 的年龄＞18 岁的患者。
结果
共对 157667 例患者进行了 957517 例患者日的随访，发生了 8157 例医院获得性感染（HAI）。多变量逻辑回归分析显示，以下变量与死亡风险增加相关：中心静脉导管相关血流感染（CLABSI；比值比[OR]，2.36；＜0.0001）、呼吸机相关事件（VAE；OR，1.51；＜0.0001）、导管相关尿路感染（CAUTI；OR，1.04；＜0.0001）和女性（OR，1.06；＜0.0001）。年龄每增加 1 岁，死亡风险增加 1%（OR，1.01；＜0.0001）。住院时间（LOS）每增加 1 个床位日，死亡风险增加 1%（OR，1.01；＜0.0001）。每增加 1 个中心静脉导管日，死亡风险增加 2%（OR，1.02；＜0.0001）。每增加 1 个导尿日，死亡风险增加 4%（OR，1.04；＜0.0001）。与机械通气使用率（OR，12.48；＜0.0001）、中上收入国家（OR，1.09；=0.033）、外科住院（OR，2.17；＜0.0001）、儿科肿瘤 ICU（OR，9.90；＜0.0001）和成人肿瘤 ICU（OR，4.52；＜0.0001）相关的死亡风险最高。大学医院的患者死亡风险最低（OR，0.61；＜0.0001）。
结论
一些与死亡风险增加相关的变量不太可能改变，如年龄、性别、国家经济、住院类型和 ICU 类型。其他一些变量可以进行干预，如 LOS、中心静脉导管使用、导尿使用和机械通气，以及 CLABSI、VAE 或 CAUTI 的获得。为降低死亡风险，我们应重点关注降低 LOS、降低中心静脉导管、导尿管和机械通气使用率以及实施 HAI 预防建议的策略。
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