Risikofaktoren für Langzeitaufenthalt und Mortalität in der Intensivmedizin : retrospektive Analyse der Patientendaten aus den Jahren 2005 bis 2007 der Klinik für operative Intensivmedizin des Universitätsklinikum Aachen

摘要

This retrospective analysis aimed to characterize the group of patients with need for long-term intensive care treatment. Demographic data, as well as clinical variables, including scores such as the SAPS-II were collected. Especially the in-hospital mortality and the long-term mortality after one year after discharge were surveyed. Additionally, risk-factors for mortality in long-term stay were identified, both for death within stay in hospital and up to one year after discharge. Significant risk factors for mortality were identified by univariate and multivariate logistic regression and Cox regression models. Evaluation of data was conducted using SPSS 11.5 [SPSS Inc., Chicago, IL, USA], and SAS V9.1.3 [SAS Institute, Cary, NC, USA] for Windows. The surveyed group of patients was equivalent to other groups in studies concerning long-term stay: The average patient was older than 60 years, with a length of stay greater than seven weeks. Pre-existing comorbidities were diverse but corresponding with distribution in general population. Most patients were submitted to the department for cardiac and thorax surgery and to the department for neurosurgery. 60% of the patients’ admissions were non-scheduled, which points out the urgency and unpredictability of many intensive care patients’ issues. Need for mechanical ventilation (MV) and failure in weaning from MV were crucial for long-term stay in the intensive care unit. Another predominant complication were infections leading to sepsis, occuring to nearly 90% of the patients and thus leading to a prolonged stay. Main risk factors for mortality in the intensive care unit, as well as for mortality up to one year after discharge were failure in weaning, number of pre-existing cardiac comorbidities and level of SAPS-II on day 30 of stay. Despite of all these complications, rate of in-hospital mortality of 25% in this cohort was reasonably good. With 40%, long-term mortality up to one year after discharge was satisfying as well, especially considering patients’ age and number of severe comorbidities. Thus, long-term stay in an intensive care unit does not seem to enhance mortality inevitably, but further efforts should be made to shorten weaning processes.