Anaemia among intensive care unit survivors and association with days alive and at home: an observational study
Anaemia among intensive care unit survivors and association with days alive and at home: an observational study
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DOI：
10.1111/anae.15483
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发表时间：
2021-04-19
期刊：
影响因子：
10.7
通讯作者：
Litton, E.
中科院分区：
文献类型：
--
作者：
van der Laan, S.;Billah, T.;Litton, E.
贫血在重症监护室出院时非常普遍，并且在重症监护室幸存者中持续存在的比例很高。贫血是否是危重疾病后恢复受损的驱动因素尚不确定。本研究的目的是检验一个假设，即在重症监护成人幸存者中，重症监护病房出院时的贫血独立预测在家的天数减少90。这项回顾性队列研究是在西澳大利亚州珀斯的一个三级重症监护病房进行的。所有年龄为bb0 = 16岁、从重症监护病房出院且无治疗限制记录的患者均被纳入研究。6358名参与者的中位年龄（IQR[范围]）为61岁（46-72岁[16-95]），包括3385名（53.2%）非计划入院者。2886例（45.4%）患者在重症监护病房出院时血红蛋白浓度< 100 g.l(-1)，这一阈值确定了一个在家天数明显较低的队列：90(中位数（IQR[范围]）80（64-85[0-90]）天和85（77-88[0-90]）天（中位数差5天，95%CI 4.4-5.5, p < 0.0001）。这种关联遵循严重反应关系，贫血越严重，在家的天数越短。考虑到预先指定的协变量，包括入院血红蛋白浓度和红细胞输血，重症监护病房出院时贫血仍然是减少在家天数的重要预测因子90，相对风险0.96 (0.93-0.98),p < 0.002。这些发现支持有必要进行干预性试验，调查这种风险是否可以改变。
Anaemia is highly prevalent at the time of intensive care unit discharge and is persistent for a high proportion of intensive care unit survivors. Whether anaemia is a driver of impaired recovery after critical illness is uncertain. The aim of this study was to test the hypothesis that, in adult intensive care survivors, anaemia at the time of intensive care unit discharge independently predicts decreased days at home-90. This retrospective cohort study was conducted in a tertiary intensive care unit in Perth, Western Australia. All patients aged >= 16 years, discharged alive from their index intensive care unit admission and without documented treatment limitations were included. Median (IQR [range]) age of the 6358 participants was 61 (46-72 [16-95]) years and included 3385 (53.2%) unplanned admissions. Intensive care unit discharge with a haemoglobin concentration < 100 g.l(-1) occurred in 2886 (45.4%) patients, a threshold that identified a cohort with significantly lower days at home-90 (median (IQR [range]) 80 (64-85 [0-90]) days vs. 85 (77-88 [0-90]) days (median difference 5 days, 95%CI 4.4-5.5, p < 0.0001). The association followed a severity-response relationship with more severe anaemia predicting lower days at home-90. When accounting for prespecified covariates including admission haemoglobin concentration and red blood cell transfusion, anaemia at intensive care unit discharge remained a significant predictor of decreased days at home-90, relative risk 0.96 (0.93-0.98), p < 0.002. These findings support the need for interventional trials investigating whether this risk is modifiable.