Suppr
超能文献

创伤性脑损伤后住院和 3 年死亡率的动态预测因素：一项回顾性队列研究。

Dynamic predictors of in-hospital and 3-year mortality after traumatic brain injury: A retrospective cohort study.

机构信息

Oxley College of Health Sciences, Communication Sciences and Disorders, The University of Tulsa, 800 S Tucker Dr, Tulsa, OK, 74104, USA.

Critical Illness, Brain Dysfunction, & Survivorship Center, Vanderbilt Center for Health Services Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 450, 4th Floor, 2525 West End Avenue Nashville, TN, 37203, USA; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, 1211 21st Avenue South, Suite 404, Nashville, TN, 37212, USA.

出版信息

Am J Surg. 2023 Apr;225(4):781-786. doi: 10.1016/j.amjsurg.2022.10.003. Epub 2022 Oct 28.

DOI:10.1016/j.amjsurg.2022.10.003

PMID:36372578

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10750767/

Abstract

BACKGROUND

Mortality risks after Traumatic Brain Injury (TBI) are understudied in critical illness. We sought to identify risks of mortality in critically ill patients with TBI using time-varying covariates.

METHODS

This single-center, six-year (2006-2012), retrospective cohort study measured demographics, injury characteristics, and daily data of acute TBI patients in the Intensive Care Unit (ICU). Time-varying Cox proportional hazards models assessed in-hospital and 3-year mortality.

RESULTS

Post-TBI ICU patients (n = 2664) experienced 20% in-hospital mortality (n = 529) and 27% (n = 706) 3-year mortality. Glasgow Coma Scale motor subscore (hazard ratio (HR) 0.58, p < 0.001), pupil reactivity (HR 3.17, p < 0.001), minimum glucose (HR 1.44, p < 0.001), mSOFA score (HR 1.81, p < 0.001), coma (HR 2.26, p < 0.001), and benzodiazepines (HR 1.38, p < 0.001) were associated with in-hospital mortality. At three years, public insurance (HR 1.78, p = 0.011) and discharge disposition (HR 4.48, p < 0.001) were associated with death.

CONCLUSIONS

Time-varying characteristics influenced in-hospital mortality post-TBI. Socioeconomic factors primarily affect three-year mortality.

摘要

背景

创伤性脑损伤（TBI）后患者的死亡率在危重病中研究较少。我们试图通过时变协变量来确定 TBI 重症患者的死亡风险。

方法

这是一项单中心、六年（2006-2012 年）回顾性队列研究，测量了重症监护病房（ICU）中急性 TBI 患者的人口统计学、损伤特征和每日数据。时变 Cox 比例风险模型评估了住院期间和 3 年的死亡率。

结果

TBI 后 ICU 患者（n=2664）的住院期间死亡率为 20%（n=529），3 年死亡率为 27%（n=706）。格拉斯哥昏迷量表运动评分（风险比（HR）0.58，p<0.001）、瞳孔反应（HR 3.17，p<0.001）、最低血糖（HR 1.44，p<0.001）、mSOFA 评分（HR 1.81，p<0.001）、昏迷（HR 2.26，p<0.001）和苯二氮䓬类药物（HR 1.38，p<0.001）与住院期间死亡率相关。3 年后，公共保险（HR 1.78，p=0.011）和出院处置（HR 4.48，p<0.001）与死亡相关。