Prevalence and long-term outcomes of patients with life-limiting illness admitted to intensive care units in Australia and New Zealand

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2024-06-01 DOI:10.1016/j.ccrj.2024.02.001

Kate Wagner MBBS, M Bioeth , Neil Orford MBBS, FCICM, FANZCA, PGDipEcho, PhD , Sharyn Milnes RN, PGCertCCN, PGDipEd, MBioeth, PhD , Paul Secombe BMBS(Hons), MClinSc, FCICM , Steve Philpot MBBS (Hons), FANZCA, FCICM, PGDipEcho, MHealth&MedLaw, GChPOM , David Pilcher MBBS, FCICM, FRACP

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引用次数: 0

Abstract

Objective

Determine the prevalence and outcomes of patients with life-limiting illness (LLI) admitted to Australian and New Zealand Intensive Care Units (ICUs).

Design, setting, participants

Retrospective registry-linked observational cohort study of all adults admitted to Australian and New Zealand ICUs from 1st January 2018 until 31st December 2020 (New Zealand) and 31st March 2022 (Australia), recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database.

Main outcome measures

The primary outcome was 1-year mortality. Secondary outcomes included ICU and hospital mortality, ICU and hospital length of stay, and 4-year survival.

Results

A total of 566,260 patients were included, of whom 129,613 (22.9%) had one or more LLI. Mortality at one year was 28.1% in those with LLI and 10.4% in those without LLI (p < 0.001). Mortality in intensive care (6.8% v 3.4%, p < 0.001), hospital (11.8% v 5.0%, p < 0.001), and at two (36.6% v 14.1%, p < 0.001), three (43.7% v 17.7%, p < 0.001) and four (55.6% v 24.5%, p < 0.001) years were all higher in the cohort of patients with LLI. Patients with LLI had a longer ICU (1.9 [0.9, 3.7] v 1.6 [0.9, 2.9] days, p < 0.001) and hospital length of stay (8.8 [49,16.0] v 7.2 [3.9, 12.9] days, p < 0.001), and were more commonly readmitted to ICU during the same hospitalisation than patients without LLI (5.2% v 3.7%, p < 0.001). After multivariate analysis the LLI with the strongest adverse effect on survival was frailty (HR 2.08, 95% CI 2.03 to 2.12, p < 0.001), followed by the presence of metastatic cancer (HR 1.97, 95% CI 1.92 to 2.02, p < 0.001), and chronic liver disease (HR 1.65, 95% CI 1.65 to 1.71, p < 0.001).

Conclusion

Patients with LLI account for almost a quarter of ICU admissions in Australia and New Zealand, require prolonged ICU and hospital care, and have high mortality in subsequent years. This knowledge should be used to identify this vulnerable cohort of patients, and to ensure that treatment is aligned to each patient's values and realistic goals.

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澳大利亚和新西兰重症监护室收治的局限生命疾病患者的患病率和长期疗效

目的确定澳大利亚和新西兰重症监护病房（ICU）收治的局限性生命疾病（LLI）患者的患病率和结局。设计、设置、参与者回顾性登记关联观察队列研究，研究对象为2018年1月1日至2020年12月31日（新西兰）和2022年3月31日（澳大利亚）期间澳大利亚和新西兰重症监护协会成人患者数据库中记录的所有澳大利亚和新西兰重症监护病房收治的成人患者。次要结果包括重症监护室和住院死亡率、重症监护室和住院时间以及 4 年生存率。结果共纳入 566,260 名患者，其中 129,613 人（22.9%）有一个或多个 LLI。有 LLI 的患者一年后的死亡率为 28.1%，无 LLI 的患者为 10.4%（p < 0.001）。有 LLI 的患者在重症监护（6.8% 对 3.4%，p < 0.001）、住院（11.8% 对 5.0%，p < 0.001）和两年（36.6% 对 14.1%，p < 0.001）、三年（43.7% 对 17.7%，p < 0.001）和四年（55.6% 对 24.5%，p < 0.001）后的死亡率均较高。与无 LLI 的患者相比，LLI 患者的重症监护室（1.9 [0.9, 3.7] v 1.6 [0.9, 2.9] 天，p < 0.001）和住院时间（8.8 [49,16.0] v 7.2 [3.9, 12.9] 天，p < 0.001）更长，在同一次住院期间再次入住重症监护室的比例更高（5.2% v 3.7%，p < 0.001）。经过多变量分析，对生存率影响最大的 LLI 是虚弱（HR 2.08，95% CI 2.03 至 2.12，p <0.001），其次是转移性癌症（HR 1.97，95% CI 1.92 至 2.02，p <0.001）和慢性肝病（HR 1.结论在澳大利亚和新西兰，LLI 患者占重症监护病房入院人数的近四分之一，需要长时间的重症监护和住院治疗，且随后几年的死亡率较高。应利用这些知识来识别这部分易受伤害的患者，并确保治疗符合每位患者的价值观和现实目标。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.