Outcomes of ICU Patients With a Discharge Diagnosis of Critical Illness Polyneuromyopathy: A Propensity-Matched Analysis.
Outcomes of ICU Patients With a Discharge Diagnosis of Critical Illness Polyneuromyopathy: A Propensity-Matched Analysis.
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DOI：
10.1097/ccm.0000000000002763
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发表时间：
2017-12
影响因子：
8.8
通讯作者：
Moss M
中科院分区：
文献类型：
--
作者：
Kelmenson DA;Held N;Allen RR;Quan D;Burnham EL;Clark BJ;Ho PM;Kiser TH;Vandivier RW;Moss M
评估出院诊断为危重病多发性神经肌病对需要入住重症监护病房 (ICU) 的一大群患者的健康相关结局的影响。具有倾向评分匹配分析的回顾性队列。大型多医院数据库的分析。未预先存在神经肌肉异常且出院诊断为危重病多发性神经病和/或肌病 (CIPNM) 的成人 ICU 患者以及成人 ICU 倾向与对照患者相匹配。没有任何。在 3,567 名出院诊断为 CIPNM 的 ICU 患者中，我们将其中 3,436 名患者与 3,436 名未出院诊断为 CIPNM 的 ICU 患者进行匹配。在倾向匹配和调整不平衡协变量之后，我们使用条件逻辑回归和重复测量模型来比较患者的结果。与未出院诊断为 CIPNM 的患者相比，出院诊断为 CIPNM 的患者 28 天无住院天数较少（6 [0.1] 与 7.4 [0.1] 天，p<0.0001），28 天无呼吸机天数较少（15.7 [0.2] vs 17.5 [0.2] 天，p<0.0001），住院费用较高（313,508） [4,853] vs 256,288 [4,470] 美元，p<0.0001）出院回家的可能性较小（15.3% vs 32.8%，p<0.0001），但住院死亡率较低（13.7% vs 18.3%，p<0.0001）。在一个大型国家数据库的倾向匹配分析中，CIPNM 的出院诊断与有害结果密切相关，包括更少的住院天数、更少的呼吸机天数、更高的住院费用和减少的出院回家率，但也意外地降低了住院死亡率。这项研究证明了 CIPNM 出院诊断的临床重要性以及有效预防干预措施的必要性。
To assess the impact of a discharge diagnosis of critical illness polyneuromyopathy on health-related outcomes in a large cohort of patients requiring intensive care unit (ICU) admission. Retrospective cohort with propensity score matched analysis. Analysis of a large multi-hospital database. Adult ICU patients without pre-existing neuromuscular abnormalities and a discharge diagnosis of critical illness polyneuropathy and/or myopathy (CIPNM) along with adult ICU propensity matched control patients. None. Of 3,567 ICU patients with a discharge diagnosis of CIPNM, we matched 3,436 of these patients to 3,436 ICU patients who did not have a discharge diagnosis of CIPNM. After propensity matching and adjusting for unbalanced covariates, we used conditional logistic regression and a repeated measures model to compare patient outcomes. Compared to patients without a discharge diagnosis of CIPNM, patients with a discharge diagnosis of CIPNM had fewer 28-day hospital free days (6 [0.1] vs 7.4 [0.1] days, p<0.0001), fewer 28-day ventilator free days (15.7 [0.2] vs 17.5 [0.2] days, p<0.0001), higher hospitalization charges (313,508 [4,853] vs 256,288 [4,470] dollars, p<0.0001), were less likely to be discharged home (15.3% vs 32.8%, p<0.0001), but had lower in-hospital mortality (13.7% vs 18.3%, p<0.0001). In a propensity matched analysis of a large national database, a discharge diagnosis of CIPNM is strongly associated with deleterious outcomes including fewer hospital free days, fewer ventilator free days, higher hospital charges, and reduced discharge home, but also an unexpectedly lower in-hospital mortality. This study demonstrates the clinical importance of a discharge diagnosis of CIPNM and the need for effective preventive interventions.