Department of Emergency Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Department of Emergency Medicine, Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia.
Emerg Med Australas. 2023 Aug;35(4):612-617. doi: 10.1111/1742-6723.14175. Epub 2023 Jan 30.
To evaluate the association between time from ED presentation to intensive care unit (ICU) transfer on mortality in patients presenting with septic shock.
Adult patients with suspected septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation trial were included. The primary outcome of this post-hoc analysis was 90-day mortality. ED-to-ICU time was analysed as both a continuous variable and a binary variable (≤ vs >4 h). Analysis incorporated mixed effects regression, with ICU site as a random effect, time-to-event analysis and competing risks regression; all with and without inverse probability of treatment weighting to account for confounding baseline covariates.
Data from 1301 patients were included. Median (interquartile range [IQR]) ED-to-ICU time was 4.3 (3.1, 6.3) hours, with 588 patients (45%) transferred within 4 h. The ≤4-h group were younger, 64 (51, 74) versus 67 (52, 76) years (P = 0.04), with higher APACHE III scores, 50 (37, 65) versus 47 (35, 62) (P = 0.002), and higher unadjusted 90-day mortality, odds ratio (OR) 1.53 (95% confidence interval 1.15, 2.03), P = 0.01. After adjustment for pre-specified confounders, the 90-day mortality OR was 1.09 (0.83, 1.44), P = 0.52. Adjusted for death as a competing event and illness severity, hospital length of stay was similar between groups, whereas ICU duration remained longer for the ≤4-h group.
In patients presenting to the ED with septic shock, ED-to-ICU time less than 4 h was not associated with altered 90-day mortality, although this should be interpreted with caution due to study limitations.
评估从急诊科（ED）转入重症监护病房（ICU）的时间与败血症休克患者死亡率之间的关联。
纳入参与澳大利亚复苏中脓毒症评估试验的疑似败血症休克的成年患者。本事后分析的主要结局为 90 天死亡率。ED 至 ICU 时间既作为连续变量，也作为二分类变量（≤4 小时 vs >4 小时）进行分析。分析采用混合效应回归模型，将 ICU 地点作为随机效应，时间事件分析和竞争风险回归；所有分析均包含了倾向评分逆概率加权法以校正混杂的基线协变量。
共纳入 1301 例患者的数据。中位数（四分位距 [IQR]）ED 至 ICU 时间为 4.3（3.1，6.3）小时，588 例患者（45%）在 4 小时内转入 ICU。≤4 小时组患者年龄更小，64（51，74）岁 vs 67（52，76）岁（P=0.04），急性生理学与慢性健康状况评分系统 III 评分更高，50（37，65）分 vs 47（35，62）分（P=0.002），未校正的 90 天死亡率更高，比值比（OR）为 1.53（95%置信区间 1.15，2.03），P=0.01。在校正了预先指定的混杂因素后，90 天死亡率的 OR 为 1.09（0.83，1.44），P=0.52。在调整死亡作为竞争事件和疾病严重程度后，两组患者的住院时间相似，而≤4 小时组 ICU 持续时间仍较长。
在因败血症休克而就诊急诊科的患者中，ED 至 ICU 的时间少于 4 小时与 90 天死亡率的改变无关，但是由于研究局限性，应谨慎解释此结果。
