Moghaddam Nader Markazi, Fathi Mohammad, Jame Sanaz Zargar Balaye, Darvishi Mohammad, Mortazavi Morteza
Department of Health Management and Economics, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran.
Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Acute Crit Care. 2023 Feb;38(1):113-121. doi: 10.4266/acc.2022.00927. Epub 2023 Feb 22.
We assessed predictors of mortality in the intensive care unit (ICU) and investigated if Glasgow coma scale (GCS) is associated with mortality in patients undergoing endotracheal intubation (EI).
From February 2020, we performed a 1-year study on 2,055 adult patients admitted to the ICU of two teaching hospitals. The outcome was mortality during ICU stay and the predictors were patients' demographic, clinical, and laboratory features.
EI was associated with a decreased risk for mortality compared with similar patients (adjusted odds ratio [AOR], 0.32; P=0.030). This shows that EI had been performed correctly with proper indications. Increasing age (AOR, 1.04; P<0.001) or blood pressure (AOR, 1.01; P<0.001), respiratory problems (AOR, 3.24; P<0.001), nosocomial infection (AOR, 1.64; P=0.014), diabetes (AOR, 5.69; P<0.001), history of myocardial infarction (AOR, 2.52; P<0.001), chronic obstructive pulmonary disease (AOR, 3.93; P<0.001), immunosuppression (AOR, 3.15; P<0.001), and the use of anesthetics/sedatives/hypnotics for reasons other than EI (AOR, 4.60; P<0.001) were directly; and GCS (AOR, 0.84; P<0.001) was inversely related to mortality. In patients with trauma surgeries (AOR, 0.62; P=0.014) or other surgical categories (AOR, 0.61; P=0.024) undergoing EI, GCS had an inverse relation with mortality (accuracy=82.6%, area under the receiver operator characteristic curve=0.81).
A variety of features affected the risk for mortality in patients admitted to the ICU. Considering GCS score for EI had the potential of affecting prognosis in subgroups of patients such as those with trauma surgeries or other surgical categories.
我们评估了重症监护病房（ICU）患者的死亡率预测因素，并调查了格拉斯哥昏迷量表（GCS）与接受气管插管（EI）患者死亡率之间的关系。
自2020年2月起，我们对两家教学医院ICU收治的2055例成年患者进行了为期1年的研究。观察指标为ICU住院期间的死亡率，预测因素为患者的人口统计学、临床和实验室特征。
与相似患者相比，EI与死亡率风险降低相关（调整优势比[AOR]，0.32；P = 0.030）。这表明EI的实施指征正确。年龄增加（AOR，1.04；P < 0.001）、血压升高（AOR，1.01；P < 0.001）、呼吸问题（AOR，3.24；P < 0.001）、医院感染（AOR，1.64；P = 0.014）、糖尿病（AOR，5.69；P < 0.001）、心肌梗死病史（AOR，2.52；P < 0.001）、慢性阻塞性肺疾病（AOR，3.93；P < 0.001）、免疫抑制（AOR，3.15；P < 0.001）以及因EI以外原因使用麻醉药/镇静药/催眠药（AOR，4.60；P < 0.001）与死亡率直接相关；而GCS（AOR，0.84；P < 0.001）与死亡率呈负相关。在接受EI的创伤手术患者（AOR，0.62；P = 0.014）或其他手术类型患者（AOR，0.61；P = 0.024）中，GCS与死亡率呈负相关（准确率 = 82.6%，受试者工作特征曲线下面积 = 0.81）。
多种特征影响ICU收治患者的死亡风险。考虑EI时的GCS评分可能会影响创伤手术或其他手术类型等亚组患者的预后。
