Alrawashdeh Basel N, Hammadeen Shadi A, Hamadeneh Khaled N, Almaaitah Hind M, Altarawneh Heba A
Critical Care Medicine, Jordanian Royal Medical Services, Amman, JOR.
Anesthesiology and Critical Care, Jordanian Royal Medical Services, Amman, JOR.
Cureus. 2025 Feb 6;17(2):e78605. doi: 10.7759/cureus.78605. eCollection 2025 Feb.
The main purpose of the study was to find out how the oral health of critically ill patients affected the chances of bad outcomes such as longer hospital stays and death while taking into account possible confounders such as how often the critically ill patients used chlorhexidine mouthwash each week and their sequential organ failure assessment scores.
We conducted a retrospective observational study on 4,999 critically ill patients admitted to the King Hussein Medical Centre in Amman, Jordan, from January 2018 to May 2022. The patients were adults and the elderly, with a minimum of three consecutive days of admission. The study encompassed both mechanically ventilated and non-ventilated patients. We divided the cohort into two groups, Group I, based on favorable adverse outcomes, and Group II, based on unfavorable adverse outcomes. We examined the weekly administration of chlorhexidine mouthwash during critical care admissions as the principal variable. We conducted multiple logistic regression analyses to evaluate the correlation between weekly mouthwash usage and the likelihood of poorer outcomes while accounting for oral health conditions and the risk of critical illness.
A retrospective study of 4,999 critically ill patients revealed that 2,370 patients (47.41%) achieved improved composite outcomes of interest (cOI), while 2,629 patients (52.26%) fell into the inferior cOI group. The overall mortality rate in the lower socioeconomic category was 1,920 patients (73%), compared to 709 patients (27%) in the survival rate. A study using multiple logistic regression showed a strong link between critically ill patients' oral health statuses (OHS), how often they used mouthwash each week (WMW), and their sequential organ failure assessment (SOFA) scores. The regression association for OHS relative to poorer cOI was positive, indicating a higher risk for poorer OHS compared to better OHS. The multivariate logistic regression model showed a predictive variability range of 69.5%-92.7%, with sensitivity indices of 98.6% for specificity, 96.7% for sensitivity, and 97.6% for accuracy.
The study found a significant association between poor OHS and adverse outcomes. Other factors in critically ill patients, such as the weekly application of chlorohexidine gluconate mouthwash and SOFA, significantly influenced this independent variable, which had a high propensity risk of 180.965. The optimal threshold for a weekly chlorhexidine mouthwash application was 15.5 times per week.
本研究的主要目的是在考虑可能的混杂因素（如重症患者每周使用洗必泰漱口水的频率及其序贯器官衰竭评估评分）的情况下，找出重症患者的口腔健康如何影响不良结局（如住院时间延长和死亡）的几率。
我们对2018年1月至2022年5月在约旦安曼侯赛因国王医疗中心收治的4999例重症患者进行了一项回顾性观察研究。患者为成年人及老年人，住院时间至少连续三天。该研究涵盖了机械通气和非通气患者。我们根据不良结局是否有利将队列分为两组，第一组为有利不良结局组，第二组为不利不良结局组。我们将重症监护住院期间洗必泰漱口水的每周使用情况作为主要变量进行研究。我们进行了多项逻辑回归分析，以评估每周漱口水使用情况与较差结局可能性之间的相关性，同时考虑口腔健康状况和重症疾病风险。
对4999例重症患者的回顾性研究显示，2370例患者（47.41%）实现了感兴趣的综合结局改善（cOI），而2629例患者（52.26%）属于较差cOI组。社会经济地位较低类别中的总体死亡率为1920例患者（73%），生存率为709例患者（27%）。一项使用多项逻辑回归的研究表明，重症患者的口腔健康状况（OHS）、每周使用漱口水的频率（WMW）及其序贯器官衰竭评估（SOFA）评分之间存在密切联系。OHS相对于较差cOI的回归关联为正，表明与较好的OHS相比，较差的OHS风险更高。多变量逻辑回归模型显示预测变异性范围为69.5%-92.7%，特异性敏感性指数为98.6%，敏感性为96.7%，准确性为97.6%。
该研究发现OHS不佳与不良结局之间存在显著关联。重症患者的其他因素，如每周应用葡萄糖酸洗必泰漱口水和SOFA，对这个独立变量有显著影响，其倾向风险高达180.965。每周洗必泰漱口水应用的最佳阈值为每周15.5次。
