一项基于登记处的回顾性研究，探究在澳大利亚和新西兰，以过敏反应作为主要诊断入住重症监护病房的患者比例及其治疗结果。

A retrospective registry-based study into the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their outcomes in Australia and New Zealand.

作者信息

Lim Zee Zheng Jie, Karalapillai Dharshi, Kolawole Helen, Fiddes Chris, Pilcher David, Subramaniam Ashwin

机构信息

Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia.

Department of Anaesthesia and Pain Medicine, Northern Health, Epping, Victoria, Australia.

出版信息

Crit Care Resusc. 2024 Aug 3;26(3):185-191. doi: 10.1016/j.ccrj.2024.06.002. eCollection 2024 Sep.

OBJECTIVE

To describe the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their subsequent outcomes in Australia and New Zealand.

DESIGN

Retrospective observational study of ICU admissions for severe anaphylaxis.

SETTING

ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2012 and 2022.

PARTICIPANTS

Adults 16 years or older with severe anaphylaxis admitted to the ICU.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis, mortality rate, ICU and hospital length of stay.

RESULTS

7189 of the 7270 ICU admissions for severe anaphylaxis recorded between 2012 and 2022, were included in the analysis. This represented a proportion from 0.25% in 2012 to 0.43% in 2022. ICU and hospital mortality were 0.4% and 0.8%, respectively. The proportion of ICUs reporting at least one severe anaphylaxis each year increased from 61.7% in 2012 to 83.0% in 2022. Most of the patients were discharged home (92.6%, n = 6660). Increasing age (OR = 1.055; 95%CI: 1.008-1.105) and SOFA scores (OR = 1.616; 95%CI: 1.265-2.065), an immunosuppressive chronic condition (OR = 16.572; 95%CI: 3.006-91.349) and an increasing respiratory rate above 16 breaths/min (OR = 1.116; 95%CI: 1.057-1.178) predicted in-hospital mortality in patients with anaphylaxis, while higher GCS decreased in-hospital mortality (OR = 0.827; 95%CI: 0.705-0.969).

CONCLUSIONS

The overall proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis has increased. In-hospital mortality remains low despite the need for vital organ support. Further studies should investigate these identified factors that may predict in-hospital mortality among these patients.

TRIAL REGISTRATION

Not applicable.

目的

描述在澳大利亚和新西兰，以过敏反应作为主要诊断入住重症监护病房的患者比例及其后续结局。

设计

对因严重过敏反应入住重症监护病房的患者进行回顾性观察研究。

背景

2012年至2022年期间澳大利亚和新西兰重症监护学会成人患者数据库中记录的重症监护病房入院情况。

参与者

16岁及以上因严重过敏反应入住重症监护病房的成年人。

干预措施

无。

主要观察指标

以过敏反应作为主要诊断入住重症监护病房的患者比例、死亡率、重症监护病房住院时间和医院住院时间。

结果

在2012年至2022年期间记录的7270例因严重过敏反应入住重症监护病房的患者中，7189例纳入分析。这一比例从2012年的0.25%上升至2022年的0.43%。重症监护病房死亡率和医院死亡率分别为0.4%和0.8%。每年报告至少一例严重过敏反应的重症监护病房比例从2012年的61.7%增至2022年的83.0%。大多数患者出院回家（92.6%，n = 6660）。年龄增长（比值比=1.055；95%置信区间：1.008 - 1.105）、序贯器官衰竭评估（SOFA）评分升高（比值比=1.616；95%置信区间：1.265 - 2.065）、免疫抑制慢性病（比值比=16.572；95%置信区间：3.006 - 91.349）以及呼吸频率高于16次/分钟且升高（比值比=1.116；95%置信区间：1.057 - 1.178）可预测过敏反应患者的院内死亡率，而格拉斯哥昏迷量表（GCS）评分较高则降低院内死亡率（比值比=0.827；95%置信区间：0.705 - 0.969）。

结论

以过敏反应作为主要诊断入住重症监护病房的患者总体比例有所增加。尽管需要重要器官支持，但院内死亡率仍然较低。进一步研究应调查这些已确定的可能预测这些患者院内死亡率的因素。

试验注册

不适用。