Characteristics and Outcomes of Young Adult Patients with Severe Sepsis Admitted to Pediatric Intensive Care Units Versus Medical/Surgical Intensive Care Units.
Characteristics and Outcomes of Young Adult Patients with Severe Sepsis Admitted to Pediatric Intensive Care Units Versus Medical/Surgical Intensive Care Units.
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DOI：
10.1177/08850666221119685
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发表时间：
2023-03
影响因子：
3.1
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中科院分区：
文献类型：
--
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年轻人在儿科和成人护理环境中接受严重的脓毒症治疗。然而，关于青少年败血症在儿科和成人医院环境中的结局差异知之甚少。使用2010-2015年的Truven MarketScan数据库，我们分别使用Logistic回归模型和加速时间失败模型比较了在儿科重症监护病房(PICU)和内科ICU(MICU)/外科ICU(SICU)接受严重脓毒症治疗的18-26岁年轻人的住院死亡率和住院时间。通过复杂慢性病(CCC)和查尔森合并症指数(CCI)确定合并症。在18900名因严重脓毒症住院的年轻人中，163人(0.9%)在PICU接受治疗，952人(5.0%)在MICU/SICU接受治疗。与MICU/SICU患者相比，PICU患者更有可能合并疾病。与PICU患者相比，MICU/SICU患者在调整了年龄、性别、医疗补助状况和合并症后住院死亡率较低(调整CCC，优势比[OR]：0.50，95%CI 0.29-0.89；调整CCI，OR：0.51，95%CI 0.29-0.94)。严重脓毒症的青壮年患者的调整住院时间无差异(调整CCC，事件时间比[ETR]：1.14，95%CI为0.94~1.38；调整CCI，ETR：1.09，95%CI为0.90~1.33)。与MICU/SICU相比，患有严重脓毒症的年轻人在PICU接受治疗时，调整后的死亡率更高。然而，在逗留时间上没有区别。死亡率的差异可能是由于患者群体的显著差异，包括共病状态。
Young adults receive severe sepsis treatment across pediatric and adult care settings. However, little is known about young adult sepsis outcome differences in pediatric versus adult hospital settings. Using Truven MarketScan database from 2010–2015, we compared in-hospital mortality and hospital length of stay in young adults ages 18–26 treated for severe sepsis in Pediatric Intensive Care Units (PICUs) versus Medical ICUs (MICUs)/Surgical ICUs (SICUs) using logistic regression models and accelerated time failure models, respectively. Comorbidities were identified using Complex Chronic Conditions (CCC) and Charlson Comorbidity Index (CCI). Of the 18 900 young adults hospitalized with severe sepsis, 163 (0.9%) were treated in the PICU and 952 (5.0%) in the MICU/SICU. PICU patients were more likely to have a comorbid condition compared to MICU/SICU patients. Compared to PICU patients, MICU/SICU patients had a lower odds of in-hospital mortality after adjusting for age, sex, Medicaid status, and comorbidities (adjusting for CCC, odds ratio [OR]: 0.50, 95% CI 0.29–0.89; adjusting for CCI, OR: 0.51, 95% CI 0.29–0.94). There was no difference in adjusted length of stay for young adults with severe sepsis (adjusting for CCC, Event Time Ratio [ETR]: 1.14, 95% CI 0.94–1.38; adjusting for CCI, ETR: 1.09, 95% CI 0.90–1.33). Young adults with severe sepsis experience higher adjusted odds of mortality when treated in PICUs versus MICU/SICUs. However, there was no difference in length of stay. Variation in mortality is likely due to significant differences in the patient populations, including comorbidity status.
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