Tirupakuzhi Vijayaraghavan Bharath Kumar, Rashan Aasiyah, Ramakrishnan Nagarajan, Haniffa Rashan, Beane Abi, Adhikari Neill K J, Lone Nazir, de Keizer Nicolette
Department of Critical Care Medicine, Apollo Main Hospital, Chennai, Tamil Nadu, India.
Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom.
Crit Care Med. 2025 Aug 1;53(8):e1641-e1649. doi: 10.1097/CCM.0000000000006743. Epub 2025 Jun 16.
Among patients admitted to an ICU in high-income countries, persistent critical illness arises when the admission diagnosis and acute physiologic derangements no longer predict outcomes better than antecedent characteristics. We evaluated this phenomenon in India.
Cohort study.
Fifty-six ICUs in India belonging to the Indian Registry of Intensive Care.
Adult critically ill patients.
None.
We evaluated associations of acute illness characteristics (admission diagnoses and acute physiology variables), antecedent characteristics (age, sex, and Charlson Comorbidity Index), and their combination on hospital mortality. Analyses used generalized mixed-effects models. In post hoc analyses, we compared patients with or without a long ICU stay. We included 42,925 patients; hospital mortality was 17.4%. Prognostic performance of acute illness characteristics declined over time (area under the receiver operating characteristic curve [AUROC], 0.76 at admission; 0.69 at day 7) and was consistently poor for antecedent characteristics (AUROC, 0.56 at admission and day 7). Patients with ICU stay greater than 7 days were sicker (median [interquartile range (IQR)]; Acute Physiology and Chronic Health Evaluation II, 14 [9, 19] vs. 10 [6, 15]; p < 0.001), with higher hospital mortality (33.1% vs. 14.6%; odds ratio, 2.17; 95% CI, 2.03-2.31) and ICU mortality (30.3% vs. 13.2%); receipt of invasive ventilation (51.7% vs. 19.5%), noninvasive ventilation (18.4% vs. 7.6%), vasopressors (34.7% vs. 19.1%), and kidney replacement therapy (11.4% vs. 6.1%) were all significantly higher among those staying in ICU greater than 7 days.
In this cohort of critically ill patients in India, as ICU stay increased, the prognostic performance of acute illness characteristics decreased whereas that of antecedent characteristics remained poor. Although patients with ICU stay greater than 7 days had higher mortality and received more organ support, the definition of persistent critical illness from high-income country cohorts was not replicated.
在高收入国家入住重症监护病房（ICU）的患者中，当入院诊断和急性生理紊乱对预后的预测能力不再优于先前特征时，就会出现持续性危重病。我们在印度评估了这一现象。
队列研究。
印度56个属于印度重症监护登记处的ICU。
成年危重病患者。
无。
我们评估了急性疾病特征（入院诊断和急性生理学变量）、先前特征（年龄、性别和查尔森合并症指数）及其组合与医院死亡率之间的关联。分析采用广义混合效应模型。在事后分析中，我们比较了ICU住院时间长和短的患者。我们纳入了42925例患者；医院死亡率为17.4%。急性疾病特征的预后性能随时间下降（受试者工作特征曲线下面积[AUROC]，入院时为0.76；第7天时为0.69），而先前特征的预后性能一直较差（入院时和第7天时AUROC均为0.56）。ICU住院时间超过7天的患者病情更重（中位数[四分位间距（IQR）]；急性生理与慢性健康状况评估II，14[9，19]对10[6，15]；p<0.001），医院死亡率更高（33.1%对14.6%；比值比，2.17；95%CI，2.03 - 2.31）和ICU死亡率更高（30.3%对13.2%）；在ICU住院时间超过7天的患者中，接受有创通气（51.7%对19.5%）、无创通气（18.4%对7.6%）、血管活性药物（34.7%对19.1%）和肾脏替代治疗（11.4%对6.1%）的比例均显著更高。
在印度的这组危重病患者中，随着ICU住院时间的增加，急性疾病特征的预后性能下降，而先前特征的预后性能仍然较差。尽管ICU住院时间超过7天的患者死亡率更高且接受了更多的器官支持，但高收入国家队列中持续性危重病的定义并未得到重现。
