急诊滞留时间与需要入住ICU的脓毒症患者的预后分析:一项基于大型数据库的回顾性队列研究

Emergency Department Length of Stay and the prognosis of septic patients requiring ICU admission:A retrospective cohort study

目的评价急诊滞留时间(Emergency Department Length of Stay,ED-LOS)与需要入住重症监护病房(Intensive Care Unit,ICU)的脓毒症患者预后之间的关系。方法此回顾性队列研究从重症监护医学信息数据库(Medical Information Mark for Intensive Care,MIMIC Ⅲ)提取出需要从急诊科(Emergency Department,ED)直接转入ICU的脓毒症患者的相关信息,以ED-LOS是否大于4 h将研究人群分成两组,比较两组患者结局指标的差异。倾向性评分匹配(Propensity Score Matching,PSM)用于平衡两组间的基线特征。多因素logistic回归分析探讨不同变量对院内死亡率、机械通气及肾脏替代治疗等临床结局的影响;绘制两组患者的28天Kaplan-Meier生存曲线,并进行log-rank检验。结果共有4 918例患者纳入分析,进行1:1 PSM后,两组均有1 895例患者,两组患者的院内死亡率及总住院时间无统计学差异。而与ED-LOS≤4 h组患者相比,>4 h组有更多的患者需要进行机械通气(29.4%vs. 39.9%,P <0.001)以及肾脏替代治疗(8.6%vs.9.8%,P=0.022)。多因素logistic回归分析提示:ED-LOS并未增加或降低院内死亡率(OR=1.016,95%CI:0.988-1.045,P=0.258);而ED-LOS降低了患者需要进行机械通气(机械通气:OR=0.912,95%CI:0.888-0.936,P=0.000)及肾脏替代治疗(OR=0.963,95%CI:0.954-0.972,P=0.021)的风险。结论 ED-LOS与脓毒症患者的院内死亡率及总住院时间并不存在相关性;但ED-LOS的延长,使得更多的脓毒症患者需要进行呼吸支持及肾脏支持治疗。

Objective To evaluate the relationship between Emergency Department Length of Stay(ED-LOS) and the prognosis of septic patients who need to be transferred from ED to ICU. Methods In this retrospective cohort study, the information on septic patients was extracted from Medical Information Mark for Intensive Care Ⅲ(MIMIC Ⅲ). The samples were divided into two groups according to whether ED-LOS was longer than 4 hours, and the outcome indicators between the two groups were compared. Propensity Score Matching(PSM) was used to balance the baseline characteristics between the two groups. Multivariate logistic regression analysis was carried out to discuss the effects of different variables on hospital mortality, mechanical ventilation and renal replacement therapy. The 28-day Kaplan-Meier survival curves of the two groups were drawn and the log-rank test was performed. Results A total of 4,918 patients were included in the analysis. After 1: 1 PSM, there were 1,895 patients in each group. There was no significant difference in hospital mortality and total length of hospital stay between the two groups. Compared with the ≤ 4 hours group, more patients in > 4 hours group received mechanical ventilation(29.4% vs 39.9%, P< 0.001) and renal replacement therapy(8.6% vs 9.8%, P= 0.022). Multivariate logistic regression analysis showed that ED-LOS did not increase or decrease the in-hospital mortality(OR= 1.016, 95% confidence interval: 0.988-1.045, P= 0.258);ED-LOS reduced the risk of mechanical ventilation(mechanical ventilation: OR=0.912, 95% CI: 0.888-0.936, P=0.000) and renal replacement therapy(OR=0.963, 95% CI: 0.954-0.972, P=0.021). Conclusion There is no correlation between ED-LOS and in-hospital mortality and total length of hospital stay, but prolonged ED-LOS is associated with more respiratory support and renal support treatment among patients with sepsis.