Amarilla Victor Galvani Vianna, Miamoto Isabel Mieko, Dyba Daiane, Silva-Jr João Manoel, Gomes Brenno Cardoso
Health Sciences Sector, Federal University of Paraná Hospital Complex, Rua Padre Camargo, 280, Curitiba, PR, Brazil.
Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Intern Emerg Med. 2025 Jun 4. doi: 10.1007/s11739-025-03998-0.
The decision to admit patients to the intensive care unit (ICU) can be difficult, especially when it is unclear which patients will benefit the most. Therefore, identifying the determinants of complications can aid in patient therapy. The aim of this study was to evaluate the characteristics of patients who were admitted late to the ICU and identify the main factors that contribute to their admission. This case‒control study was conducted in a tertiary hospital and included 4 years of follow-up (using medical records). The study included patients who were at risk for deterioration and admitted to clinical wards. The main measure, whether ICU admission was needed or not, was compared among the patients. We included 170 patients aged 60.6 ± 13.6 years. The multivariate analysis revealed that the qSOFA and CCI values were independent factors in determining whether a patient required ICU admission (OR = 8.25, CI 95% = 4.4-15.3 and OR = 1.37, CI 95% = 1.03-1.82, respectively); the ROC value was 0.89 (95% CI 0.83-0.93). The Cox regression model used to assess 90-day survival revealed that only the qSOFA value was strongly associated with shorter survival (qSOFA = 1, HR = 9.42, P = 0.03; qSOFA = 2, HR = 17.7, P = 0.005; and qSOFA = 3, HR = 73.7, P < 0.001). Although selecting high-risk patients for ICU admission is a difficult task, the qSOFA score appears to be a useful tool for differentiating patients.
决定将患者收入重症监护病房（ICU）可能很困难，尤其是在不清楚哪些患者将受益最大时。因此，识别并发症的决定因素有助于患者治疗。本研究的目的是评估ICU延迟收治患者的特征，并确定导致其收治的主要因素。这项病例对照研究在一家三级医院进行，包括4年的随访（使用病历）。该研究纳入了有病情恶化风险并入住临床病房的患者。比较了患者中是否需要入住ICU这一主要指标。我们纳入了170名年龄为60.6±13.6岁的患者。多变量分析显示，qSOFA和CCI值是决定患者是否需要入住ICU的独立因素（OR分别为8.25，95%CI为4.4 - 15.3；OR为1.37，95%CI为1.03 - 1.82）；ROC值为0.89（95%CI为0.83 - 0.93）。用于评估90天生存率的Cox回归模型显示，只有qSOFA值与较短生存期密切相关（qSOFA = 1，HR = 9.42，P = 0.03；qSOFA = 2，HR = 17.7，P = 0.005；qSOFA = 3，HR = 73.7，P < 0.001）。尽管选择高危患者入住ICU是一项艰巨的任务，但qSOFA评分似乎是区分患者的有用工具。
