Zhou Qingqing, Qian Hebu, Yang Aixiang, Lu Jian, Liu Jun
Gusu School of Nanjing Medical University, Department of Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Clinical Medical Center of Critical Care Medicine, Suzhou 215001, China.
Department of Critical Care Medicine, Suzhou Ninth People's Hospital, The Affiliated Wujiang Hospital of Nantong University, Suzhou 215200, China.
Shock. 2023 Jan 1;59(1):5-11. doi: 10.1097/SHK.0000000000002035. Epub 2022 Nov 17.
Objective: The aims of this study were to investigate and compare the clinical features and prognosis of chronic critical illness (CCI)/persistent inflammation immunosuppression and catabolism (PICS). Methods: This is a prospective observational clinical study. During this study period, we collect intensive care unit patients' data from Suzhou Municipal Hospital and Suzhou Ninth People's Hospital. All patients older than 18 years were included, and according to the corresponding exclusion and diagnostic criteria, they were divided into four groups: PICS group, CCI group, CCI and PICS group (CCI + PICS), and neither CCI nor PICS group (NCCI + NPICS) and collected and recorded age, sex, hospital time, hospital diagnosis, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, C-reactive protein, absolute value lymphocyte count, serum albumin, white blood cell count, absolute value neutrophil count, secondary infection, and 28-day case fatality rate separately. Results: A total of 687 patients were admitted to the intensive care unit during the study period. The hospitalization time less than 14 days were excluded, and 168 patients were eventually included. There are 17 in the PICS group, 71 in the CCI group, 50 in the CCI + PICS group, and 30 in the NCCI + NPICS group. Baseline characteristics showed statistically significant differences in Sequential Organ Failure Assessment, length of hospital stay, and 28-day mortality among four groups. Baseline main indicator and multiple comparisons showed that the CCI + PICS group had longer hospital stay, worse prognosis, and more adverse outcomes. Multivariate analysis showed that final age, C-reactive protein on days 14 and 21, and serum albumin on days 1 and 21 had an impact on the prognosis ( P < 0.05). Conclusion: The clinical prognosis of the four groups decreased in order of NCCI + NPICS, CCI, PICS, and CCI + PICS. Our finding of clinically isolated PICS may indicate that PICS acts as an inducement or independent factor to worsen the prognosis of CCI.
本研究旨在调查和比较慢性危重病（CCI）/持续性炎症免疫抑制和分解代谢（PICS）的临床特征及预后。方法：这是一项前瞻性观察性临床研究。在研究期间，我们收集了苏州市立医院和苏州第九人民医院重症监护病房患者的数据。纳入所有年龄大于18岁的患者，并根据相应的排除和诊断标准，将他们分为四组：PICS组、CCI组、CCI合并PICS组（CCI + PICS）和既无CCI也无PICS组（NCCI + NPICS），分别收集并记录年龄、性别、住院时间、医院诊断、急性生理与慢性健康状况评分系统II评分、序贯器官衰竭评估评分、C反应蛋白、淋巴细胞绝对值计数、血清白蛋白、白细胞计数、中性粒细胞绝对值计数、继发感染及28天病死率。结果：研究期间共有687例患者入住重症监护病房。排除住院时间少于14天的患者，最终纳入168例患者。PICS组17例，CCI组71例，CCI + PICS组50例，NCCI + NPICS组30例。基线特征显示四组在序贯器官衰竭评估、住院时间和28天死亡率方面存在统计学显著差异。基线主要指标及多重比较显示，CCI + PICS组住院时间更长、预后更差且不良结局更多。多因素分析显示，最终年龄、第14天和第21天的C反应蛋白以及第1天和第21天的血清白蛋白对预后有影响（P < 0.05）。结论：四组的临床预后按NCCI + NPICS、CCI、PICS、CCI + PICS的顺序依次降低。我们关于临床孤立性PICS的发现可能表明，PICS是使CCI预后恶化的诱因或独立因素。
