Outcomes and Mortality Prediction Model of Critically Ill Adults With Acute Respiratory Failure and Interstitial Lung Disease
Outcomes and Mortality Prediction Model of Critically Ill Adults With Acute Respiratory Failure and Interstitial Lung Disease
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DOI：
10.1016/j.chest.2018.01.006
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发表时间：
2018-06-01
期刊：
影响因子：
9.6
通讯作者：
Baldwin, Matthew R.
中科院分区：
文献类型：
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作者：
Gannon, Whitney D.;Lederer, David J.;Baldwin, Matthew R.
背景：我们的目的是研究间质性肺疾病（ILD）合并急性呼吸衰竭混合人群的短期和长期死亡率，并确定院内死亡风险较低和较高的人群。方法：我们进行了一项单中心回顾性队列研究，纳入了2010年至2014年期间因呼吸衰竭在三级医院ICU住院的126例ILD患者，这些患者在住院期间未接受肺移植。我们使用泊松回归检查了icu第1天特征与住院和1年死亡率的关系，并使用Kaplan-Meier曲线检查了生存率。我们使用惩罚回归模型创建了住院死亡率的风险评分。结果：住院死亡率66%，1年死亡率80%。与无法分类的ILD相比，结缔组织病相关ILD患者有更好的短期和长期死亡率（调整相对危险度，0.6;95% CI, 0.3-0.9；相对危险度，0.6;95% CI, 0.4-0.9）。我们的预测模型包括男性、间质性肺纤维化诊断、使用有创机械通气和/或体外生命支持、入住ICU后24小时内不能走动、BMI和简化急性生理评分- ii。乐观校正的c -统计量为0.73，模型校正良好（P = 0.99）。低、中、高风险组的住院死亡率分别为33%、65%和96%。结论：我们创建了一个风险评分，将ILD合并急性呼吸衰竭患者的院内死亡风险从低到高进行分类。该分数可以帮助医疗服务提供者为这些患者及其家属提供咨询。
BACKGROUND: We aimed to examine short- nd long-term mortality in a mixed population of patients with interstitial lung disease (ILD) with acute respiratory failure, and to identify those at lower vs higher risk of in-hospital death.METHODS: We conducted a single-center retrospective cohort study of 126 consecutive adults with ILD admitted to an ICU for respiratory failure at a tertiary care hospital between 2010 and 2014 and who did not undergo lung transplantation during their hospitalization. We examined associations of ICU-day 1 characteristics with in-hospital and 1-year mortality, using Poisson regression, and examined survival using Kaplan-Meier curves. We created a risk score for in-hospital mortality, using a model developed with penalized regression.RESULTS: In-hospital mortality was 66%, and 1-year mortality was 80%. Those with connective tissue disease-related ILD had better short-term and long-term mortality compared with unclassifiable ILD (adjusted relative risk, 0.6; 95% CI, 0.3-0.9; and relative risk, 0.6; 95% CI, 0.4-0.9, respectively). Our prediction model includes male sex, interstitial pulmonary fibrosis diagnosis, use of invasive mechanical ventilation and/or extracorporeal life support, no ambulation within 24 h of ICU admission, BMI, and Simplified Acute Physiology Score-II. The optimism-corrected C-statistic was 0.73, and model calibration was excellent (P = .99). In-hospital mortality rates for the low-, moderate-, and high-risk groups were 33%, 65%, and 96%, respectively.CONCLUSIONS: We created a risk score that classifies patients with ILD with acute respiratory failure from low to high risk for in-hospital mortality. The score could aid providers in counseling these patients and their families.