Characteristics of Critically Ill Patients in ICUs in Mainland China
Characteristics of Critically Ill Patients in ICUs in Mainland China
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DOI：
10.1097/ccm.0b013e31826a4082
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发表时间：
2013-01-01
影响因子：
8.8
通讯作者：
Zhou, Lihua
中科院分区：
文献类型：
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作者：
Du, Bin;An, Youzhong;Zhou, Lihua
目的：我们试图描述中国大陆重症监护病房收治的危重患者的人口统计学资料、病例组合、干预措施和临床结局。（2009年7月1日至2009年8月31日）前瞻性、观察性队列研究。地点：中国大陆22个ICU。患者：研究期间入住ICU的成人患者，ICU住院时间>24小时。干预措施：无。测量和主要结果：在病例报告表中记录患者特征，包括人口统计学、基础疾病、疾病严重程度、入院状态、并发症、ICU住院期间的干预和治疗以及临床结局。主要结局指标为全因住院死亡率。住院死亡率的独立预测因素采用多因素logistic回归分析。1297例患者符合本研究的入选标准，821例（63.3%）为男性，平均年龄为58.5 ± 19.2岁。平均急性生理学和慢性健康评估II评分为18.0 ± 8.1，平均序贯器官衰竭评估评分为65 ± 3.8。三分之一的患者术后入住ICU。765例患者（59.0%）发生感染，其次是严重脓毒症或脓毒性休克（484例，37.3%）、急性肾损伤（398例，30.7%）和急性肺损伤/急性呼吸窘迫综合征（351例，27.1%）。几乎四分之三的患者使用机械通气，而173例患者（13.3%）使用任何类型的肾脏替代治疗。住院死亡率为20.3%。多因素Logistic回归分析发现，急性生理学和慢性健康状况评估II评分、实体瘤、严重脓毒症/脓毒性休克、急性肺损伤/急性呼吸窘迫综合征和急性肾损伤是住院死亡率的独立危险因素。中国大陆ICU重症患者的病例组合与西方国家相似，尽管西方和中国ICU之间在重症监护室入院率和疾病严重程度方面存在显著差异。(Crit Care Med 2013; 41：84-92）
Objectives: We sought to describe the demographics, case mix, interventions, and clinical outcome of critically ill patients admitted to ICUs in Mainland China.Design: A 2-month (July 1, 2009, to August 31, 2009) prospective, observational cohort study.Setting: Twenty-two ICUs in Mainland China.Patients: Adult patients admitted to participating ICUs during the study period with an ICU length of stay >24 hrs.Interventions: None.Measurements and Main Results: Patient characteristics, including demographics, underlying diseases, severity of illness, admission status, complications, intervention and treatment during ICU stay, and clinical outcome were recorded in case report form. The primary outcome measure was all-cause hospital mortality. Independent predictors for hospital mortality were determined with multivariate logistic regression analysis. One thousand two hundred ninety-seven patients met the inclusion criteria for the study, 821 (63.3%) were male, and mean age was 58.5 +/- 19.2 yrs. Mean Acute Physiology and Chronic Health Evaluation II score was 18.0 +/- 8.1, and mean Sequential Organ Failure Assessment score was 65 +/- 3.8. One third of the patients were postoperative ICU admissions. Seven hundred sixty-five patients (59.0%) developed infections, followed by severe sepsis or septic shock (484, 37.3%), acute kidney injury (398, 30.7%), and acute lung injury/acute respiratory distress syndrome (351, 27.1%). Mechanical ventilation was used in almost three fourths of the patients, whereas any type of renal replacement therapy was used in 173 patients (13.3%). Hospital mortality was 20.3%. Multivariate logistic regression analysis found that Acute Physiology and Chronic Health Evaluation II score, solid tumor, severe sepsis/septic shock, acute lung injury/acute respiratory distress syndrome, and acute kidney injury were independent risk factors for hospital mortality.Conclusions: Critically ill patients in ICUs in Mainland China exhibited a case mix similar to those of Western countries, although there are significant differences in intensive care unit admission rates and disease severity between Western and Chinese ICUs. (Crit Care Med 2013; 41:84-92)