Extracranial complications in patients with acute brain injury: a post-hoc analysis of the SOAP study
Extracranial complications in patients with acute brain injury: a post-hoc analysis of the SOAP study
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DOI：
10.1007/s00134-007-0974-7
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发表时间：
2008-04-01
影响因子：
38.9
通讯作者：
Vincent, Jean-Louis
中科院分区：
文献类型：
--
作者：
Mascia, Luciana;Sakr, Yasser;Vincent, Jean-Louis
目的：在一项国际队列观察性研究中，评估急性神经系统患者非神经系统器官功能障碍的发生率和严重程度及其对结局的影响。设计和设置：在24个欧洲国家的198个重症监护室（ICU）中进行的观察性急性病患者脓毒症发生率（SOAP）研究的数据库分析。患者：2002年5月1日至15日期间入住参与ICU的所有成人患者。在SOAP数据库中的3，147名患者中，373名（12%）因神经系统诊断而入院，包括154名（41%）创伤性脑损伤和186名（50%）脑血管意外。测量和结果：患者随访至死亡、出院或60天。神经科患者较非神经科患者年轻，创伤发生率较高，合并症较少。神经系统患者发生ICU获得性败血症和呼吸衰竭的频率高于其他患者。神经系统患者的ICU和住院死亡率高于非神经系统患者，ICU住院时间长于非神经系统患者。多变量logistic分析显示，除了格拉斯哥昏迷评分（GCS）和非创伤性脑损伤外，心血管衰竭、肝功能衰竭和ALI/ARDS是唯一与神经系统诊断患者ICU死亡风险较高独立相关的因素。结论：虽然神经系统患者更年轻，合并症较少，但他们比其他患者更频繁地发生ICU获得性脓毒症和呼吸衰竭。应努力减少心血管、肝脏和呼吸系统并发症。
Objective: To assess the incidence and severity of nonneurological organ dysfunction and its effect on outcome in acute neurological patients in an international cohort observational study. Design and setting: Analysis of database from the observational Sepsis Occurrence in Acutely Ill Patients (SOAP) study in 198 intensive care units (ICUs) in 24 European countries. Patients: All adult patients admitted to the participating ICUs between 1 and 15 May 2002. Of the 3,147 patients in the SOAP database 373 (12%) were admitted with a neurological diagnosis, including 154 (41%) with traumatic brain injury and 186 (50%) with cerebrovascular accident. Measurements and results: Patients were followed until death, hospital discharge, or for 60 days. Neurological patients were younger and had a higher incidence of trauma and fewer comorbidities than nonneurological patients. Neurological patients developed ICU-acquired sepsis and respiratory failure more frequently than the other patients. ICU and hospital mortality rates were higher and ICU length of stay longer in neurological than in nonneurological patients. Multivariate logistic analysis showed that, in addition to the Glasgow Coma Score (GCS) and the presence of nontraumatic brain injury, cardiovascular failure, hepatic failure, and ALI/ARDS were the only factors independently associated with a higher risk of death in the ICU in patients with a neurological diagnosis. Conclusions: Although neurological patients were younger and had fewer comorbidities, they developed ICU-acquired sepsis and respiratory failure more frequently than other patients. Efforts should be oriented to reduce cardiovascular, hepatic, and respiratory complications.