Alkeridy Walid A, Alayed Khalid M, AlMuhaidib Shadan, Alageel Mohammed Khalid, Alqahtani Sarah Ahmed, Dher Shatha Bin, Almotairi Abdulaziz M, Lim Claire Ann, Alzahrani Musa F
Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Medicine, Division of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2025 May 28;20(5):e0324482. doi: 10.1371/journal.pone.0324482. eCollection 2025.
Goals of care (GOC) discussions are essential for aligning medical management with the values of critically ill patients, particularly those requiring vasopressors, such as dopamine. To evaluate GOC discussions in terms of prevalence, factors associated with documentation, and impact on survival among critically ill patients requiring vasopressors for hemodynamic support.
We conducted a retrospective cohort study at a tertiary healthcare facility in Riyadh, Saudi Arabia, focusing on patients admitted to intensive care units (ICUs) and internal medicine (IM) wards. The study included adult in patients who received dopamine during their hospital stay. Factors associated with GOC documentation were identified using logistic regression analysis. The 30-day and 1-year survival rates according to GOC discussions were analyzed using Kaplan-Meier survival curves, which were compared using the log-rank test.
Of 301 patients, 56.8% were men and 64.8% were aged ≥60 years. GOC discussions were documented in 61.8% of patients and were more frequent among older patients (≥60 years) than among younger patients (73.1% vs. 51.3%, p < 0.001) and in those with higher APACHE II scores (median 21.0 vs. 18.0, p = 0.001). Multivariable analysis identified age ≥ 60 years as independent precipitating factor of GOC discussions (odds ratio 2.41, 95% confidence interval 1.34-4.32, p = 0.003). The study found significantly lower survival rates at both 30 days and 1 year among patients who had documented GOC discussions.
GOCs were more prevalent among critically ill older patients. The study found significantly higher mortality rates at both 30 days and 1 year among patients who had documented GOC discussions. These findings highlight the need for institutional strategies to integrate GOC discussions into routine care and address their potential implications on patient outcomes.
护理目标（GOC）讨论对于使医疗管理与重症患者的价值观保持一致至关重要，尤其是那些需要使用血管加压药（如多巴胺）的患者。旨在评估GOC讨论在患病率、与记录相关的因素以及对需要血管加压药进行血流动力学支持的重症患者生存率的影响。
我们在沙特阿拉伯利雅得的一家三级医疗机构进行了一项回顾性队列研究，重点关注入住重症监护病房（ICU）和内科（IM）病房的患者。该研究纳入了在住院期间接受多巴胺治疗的成年住院患者。使用逻辑回归分析确定与GOC记录相关的因素。根据GOC讨论情况，使用Kaplan-Meier生存曲线分析30天和1年生存率，并使用对数秩检验进行比较。
301例患者中，56.8%为男性，64.8%年龄≥60岁。61.8%的患者记录了GOC讨论，老年患者（≥60岁）比年轻患者更频繁（73.1%对51.3%，p<0.001），且急性生理与慢性健康状况评分系统（APACHE）II评分较高的患者中也更频繁（中位数21.0对18.0，p = 0.001）。多变量分析确定年龄≥60岁是GOC讨论的独立促成因素（优势比2.41，95%置信区间1.34 - 4.32，p = 0.003）。研究发现，记录了GOC讨论的患者在30天和1年时的生存率均显著较低。
GOC在重症老年患者中更为普遍。研究发现，记录了GOC讨论的患者在30天和1年时的死亡率均显著较高。这些发现凸显了制定机构策略将GOC讨论纳入常规护理并解决其对患者结局潜在影响的必要性。
