Chen J, Chen J, Shao L F, Li C, Liu X Y, Su H B, Mu J S, Hu J H
Graduate School of PLA General Hospital, Beijing 100853, China Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China.
Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China.
Zhonghua Gan Zang Bing Za Zhi. 2023 Nov 20;31(11):1198-1203. doi: 10.3760/cma.j.cn501113-20230214-00056.
To investigate the real-world difference in the ICU readmission rate between the high-dependency unit (HDU) and the general ward so as to reflect the role of HDU in the diagnosis and management of patients with SLD. Patients with severe liver disease who were consecutively enrolled were step-downed to HDU and general wards in the ICU of the Fifth Medical Center of the People's Liberation Army General Hospital between July 2017 and December 2021. The main liver function indicators, MELD scores, and other were compared between the two groups. SLD severity, ICU readmission rates, and others differences were analyzed among the patients transferred to different wards. The HDU role was clarified for SLD patients' grade management. The area under the curve of the receiver operating characteristic curve (AUROC) was used to calculate and explore the feasibility of a baseline Model for End-Stage Liver Disease (MELD) score to define the treatment scope of HDU. The SLD group of patients who were transferred to HDU had significantly higher levels of the international normalized ratio, bilirubin, alanine aminotransferase, MELD score, and other factors compared to those in the general ward (P < 0.05). 70.7% of SLD patients in the HDU group had a MELD score > 17, while 61.9% of SLD patients in the general ward group had a MELD score ≤ 17. The overall ICU readmission rate in this cohort was 11.4%. The ICU readmission rate was significantly higher with a MELD score of > 23 (20.0%) than that with a MELD score of ≤ 23 (8.6%) in patients with SLD, according to the MELD score quartile P75 (P = 0.020). The ICU readmission rate was 8.2% when MELD score ≤ 23, and 9.1% when MELD score>23 in the HDU group, with no statistically significant difference (P = 1.000). However, in the general ward group, the ICU readmission rate in patients with a MELD score ≤ 23 was 8.8%, and when the MELD score was >23, the ICU readmission rate significantly increased to 36.4% (P = 0.001). The optimal cut-off value of the MELD score for predicting ICU readmission in patients with SLD in the general ward group was 23.5. The high-dependency unit can better undertake ICU step-down patients with SLD and significantly reduce the ICU readmission rate with MELD scores > 23 in practice. Additionally, ICU step-down SLD patients with a MELD score > 23 are suitable for transfer to HDU treatment.
为探讨高依赖病房（HDU）与普通病房在重症监护病房（ICU）再入院率方面的实际差异，以反映HDU在严重肝病（SLD）患者诊断和管理中的作用。2017年7月至2021年12月期间，在解放军总医院第五医学中心的ICU中，将连续纳入的严重肝病患者逐步下调至HDU和普通病房。比较两组的主要肝功能指标、终末期肝病模型（MELD）评分等。分析转入不同病房的患者之间的SLD严重程度、ICU再入院率等差异。明确HDU在SLD患者分级管理中的作用。采用受试者操作特征曲线（ROC）下面积（AUROC）来计算并探索基线MELD评分定义HDU治疗范围的可行性。与普通病房的患者相比，转入HDU的SLD患者组的国际标准化比值、胆红素、丙氨酸转氨酶、MELD评分等因素水平显著更高（P<0.05）。HDU组中70.7%的SLD患者MELD评分>17，而普通病房组中61.9%的SLD患者MELD评分≤17。该队列的总体ICU再入院率为11.4%。根据MELD评分四分位数P75，SLD患者中MELD评分>23时的ICU再入院率（20.0%）显著高于MELD评分≤23时（8.6%）（P = 0.020）。HDU组中MELD评分≤23时ICU再入院率为8.2%，MELD评分>23时为9.1%，差异无统计学意义（P = 1.000）。然而，在普通病房组中，MELD评分≤23的患者ICU再入院率为8.8%，当MELD评分>23时，ICU再入院率显著升至36.4%（P = 0.001）。普通病房组中预测SLD患者ICU再入院的MELD评分最佳截断值为23.5。在实际中，高依赖病房能够更好地接收SLD的ICU下调患者，并显著降低MELD评分>23患者的ICU再入院率。此外，MELD评分>23的ICU下调SLD患者适合转入HDU治疗。
