Timing of onset of persistent critical illness: a multi-centre retrospective cohort study
Timing of onset of persistent critical illness: a multi-centre retrospective cohort study
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DOI：
10.1007/s00134-018-5440-1
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发表时间：
2018-12-01
影响因子：
38.9
通讯作者：
Wang, Xioaming
中科院分区：
文献类型：
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作者：
Bagshaw, Sean M.;Stelfox, Henry T.;Wang, Xioaming
目的持续性危重病是慢性危重病的一种亚型，其特征是在ICU入院后的过渡期，其初步诊断和病情紧急程度在预测预后方面并不比院前特征更好。在此，我们描述了持续危重病在一个大的加拿大health region.MethodsIn这个多中心的观察性队列研究，所有患者年龄超过14岁，承认12个ICU在加拿大阿尔伯塔，2012年6月至2014年12月之间的发生和结果。主要结局为院内死亡率。ICU入院时的预测因素分为：（1）先行特征成分（例如，人口统计学、APACHE II评分的慢性健康部分、共病状况）;和（2）急性疾病部分（例如，入院时APACHE II评分、SOFA评分、主要诊断类别、手术状态、急性器官支持）。使用多种统计方法，并随机将队列分为开发和验证样本，使用logistic回归进行风险评分，我们检查了这些组成部分的死亡率预测，以表征向持续性危重病转变的时间。平均APACHE Ⅱ评分19.0分（7.9分）。住院死亡率为16.8%。在存活的ICU患者中，入院时能准确预测预后的急性疾病成分[受试者工作特征曲线下面积（AUC）0.861; 95%CI 0.860 - 0.862]逐渐丧失预测能力，9天后不再比先前特征更具预测性。这种转变定义了持续性危重病的发作，占队列的16.1%（n = 2856）。各亚组的过渡期为5 - 21天。持续性危重病患者的住院死亡率较高[23.9%vs. 15.5%，OR 1.54; 95%CI 1.43 - 1.67，p
PurposePersistent critical illness has been described as a subtype of chronic critical illness, characterized as a transition after ICU admission where primary diagnosis and illness acuity are no better at predicting outcome than pre-hospital characteristics. Herein we describe the occurrence and outcomes associated with persistent critical illness in a large Canadian health region.MethodsIn this multi-center observational cohort study, all patients aged older than 14years admitted to 12 ICUs in Alberta, Canada, between June 2012 and December 2014 were included. Primary outcome was in-hospital mortality. Predictors at ICU admission were separated into: (1) antecedent characteristics component (e.g., demographics, chronic health component of the APACHE II score, comorbid conditions); and (2) acute illness component (e.g., APACHE II score at admission, SOFA score, primary diagnostic category, surgical status, acute organ support). Using multiple statistical methods and randomly splitting the cohort into development and validation samples for risk scoring using logistic regression, we examined mortality prediction of each of these components to characterize the timing of transition to persistent critical illness.ResultsWe included 17,783 patients with a median (IQR) age 61years (49-71), 62% were male, and mean APACHE II score was 19.0 (7.9). In-hospital mortality was 16.8%. Among patients alive and in ICU, the acute illness component, which accurately predicted outcome at the time of admission [area under the receiver operating characteristics curve (AUC) 0.861; 95% CI 0.860-0.862], progressively lost predictive ability and was no longer more predictive than antecedent characteristics after 9days. This transition defined the onset of persistent critical illness and comprised 16.1% (n=2856) of the cohort. Transition ranged between 5 and 21days across subgroups. In-hospital mortality was greater for those with persistent critical illness [23.9% vs. 15.5%, odds ratio (OR) 1.54; 95% CI 1.43-1.67, p