Persistent Critical Illness Among Intensive Care Patients in India: A Registry-Embedded Cohort Study.

IF 6 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2025-06-16 DOI:10.1097/CCM.0000000000006743

Bharath Kumar Tirupakuzhi Vijayaraghavan, Aasiyah Rashan, Nagarajan Ramakrishnan, Rashan Haniffa, Abi Beane, Neill K J Adhikari, Nazir Lone, Nicolette de Keizer

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Abstract

Objectives: Among patients admitted to an ICU in high-income countries, persistent critical illness arises when the admission diagnosis and acute physiologic derangements no longer predict outcomes better than antecedent characteristics. We evaluated this phenomenon in India.

Design: Cohort study.

Setting: Fifty-six ICUs in India belonging to the Indian Registry of Intensive Care.

Patients: Adult critically ill patients.

Interventions: None.

Measurements and main results: We evaluated associations of acute illness characteristics (admission diagnoses and acute physiology variables), antecedent characteristics (age, sex, and Charlson Comorbidity Index), and their combination on hospital mortality. Analyses used generalized mixed-effects models. In post hoc analyses, we compared patients with or without a long ICU stay. We included 42,925 patients; hospital mortality was 17.4%. Prognostic performance of acute illness characteristics declined over time (area under the receiver operating characteristic curve [AUROC], 0.76 at admission; 0.69 at day 7) and was consistently poor for antecedent characteristics (AUROC, 0.56 at admission and day 7). Patients with ICU stay greater than 7 days were sicker (median [interquartile range (IQR)]; Acute Physiology and Chronic Health Evaluation II, 14 [9, 19] vs. 10 [6, 15]; p < 0.001), with higher hospital mortality (33.1% vs. 14.6%; odds ratio, 2.17; 95% CI, 2.03-2.31) and ICU mortality (30.3% vs. 13.2%); receipt of invasive ventilation (51.7% vs. 19.5%), noninvasive ventilation (18.4% vs. 7.6%), vasopressors (34.7% vs. 19.1%), and kidney replacement therapy (11.4% vs. 6.1%) were all significantly higher among those staying in ICU greater than 7 days.

Conclusions: In this cohort of critically ill patients in India, as ICU stay increased, the prognostic performance of acute illness characteristics decreased whereas that of antecedent characteristics remained poor. Although patients with ICU stay greater than 7 days had higher mortality and received more organ support, the definition of persistent critical illness from high-income country cohorts was not replicated.

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印度重症监护患者中的持续性危重疾病：一项登记嵌入队列研究。

目的：在高收入国家ICU收治的患者中，当入院诊断和急性生理紊乱不再比先前特征更好地预测预后时，就会出现持续性危重疾病。我们对印度的这种现象进行了评估。设计：队列研究。环境：印度的56个icu属于印度重症监护登记处。患者：成人危重患者。干预措施:没有。测量和主要结果：我们评估了急性疾病特征（入院诊断和急性生理变量）、前因特征（年龄、性别和Charlson合并症指数）及其组合与住院死亡率的关系。分析采用广义混合效应模型。在事后分析中，我们比较了有或没有长期ICU住院的患者。我们纳入了42925名患者；住院死亡率为17.4%。急性疾病特征的预后表现随着时间的推移而下降(入院时受试者工作特征曲线下面积[AUROC]， 0.76；在入院和第7天时，AUROC为0.56，且前因特征一直较差。ICU住院时间超过7天的患者病情加重(中位数[四分位数间距（IQR）]；急性生理与慢性健康评估II， 14 [9,19] vs. 10 [6,15]；P < 0.001)，医院死亡率更高(33.1%比14.6%；优势比，2.17；95% CI, 2.03-2.31)和ICU死亡率（30.3% vs. 13.2%）；有创通气（51.7% vs. 19.5%）、无创通气（18.4% vs. 7.6%）、血管加压药物（34.7% vs. 19.1%）和肾脏替代治疗（11.4% vs. 6.1%）在ICU住院超过7天的患者中均显著升高。结论：在印度的这组危重患者中，随着ICU住院时间的增加，急性疾病特征的预后表现下降，而先前特征的预后表现仍然很差。虽然ICU住院时间超过7天的患者死亡率更高，并获得更多的器官支持，但高收入国家队列中持续危重疾病的定义并未得到重复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.