| Literature DB >> 36224632 |
Koji Endo1, Kayoko Mizuno1, Tomotsugu Seki1,2, Woo Jin Joo1, Chikashi Takeda1,3, Masato Takeuchi1, Koji Kawakami4.
Abstract
Entities:
Year: 2022 PMID: 36224632 PMCID: PMC9555070 DOI: 10.1186/s40560-022-00638-z
Source DB: PubMed Journal: J Intensive Care ISSN: 2052-0492
Primary outcome and secondary outcomes
| Primary outcome | Overall | ICU | HDU | Point estimates | 95% CI | P value |
|---|---|---|---|---|---|---|
| 30-day mortality | 2602 (24.0) | 1576 (23.9) | 1026 (24.2) | 0.89a | 0.83–0.96 | 0.005 |
| Secondary outcomes | ||||||
| In-hospital death | 3308 (30.6) | 2041 (31.0) | 1267 (29.9) | 0.82b | 0.75–0.90 | < 0.001 |
| Hospital length of stay, days | 25.0 (13.0–46.0) | 26.0 (14.0–48.0) | 22.0 (12.0–43.0) | − 0.31c | − 1.92 to 1.28 | 0.69 |
| ICU or HDU length of stay, days | 6.0 (3.0–13.0) | 7.0(4.0–14.0) | 5.0 (3.0–10.0) | 0.11c | − 0.09 to 0.31 | 0.29 |
| Discharge to home | 3504 (32.4) | 2036 (30.9) | 1468 (34.7) | 1.03b | 0.94–1.14 | 0.42 |
| Discharge to other hospitals | 3501 (32.4) | 2289 (34.8) | 1212 (28.6) | 1.20b | 1.09–1.31 | < 0.001 |
| Discharge to nursing home | 1310 (12.1) | 812 (12.3) | 498 (11.8) | 1.12b | 0.95–1.31 | 0.15 |
| Barthel index on discharge§ | 50.0 (0.0–100.0) | 50.0 (0.0–100.0) | 45.0 (0.0–100.0) | 2.32c | 0.12–4.53 | 0.038 |
Data are presented as number of events (%) or mean (IQR)
IQR interquartile range, CI confidence interval, CRRT continuous renal replacement therapy, PMX-DHP polymyxin B immobilized fiber column direct hemoperfusion, VA-ECMO venoatrial extracorporeal membrane oxygenation, IABP intra-aortic balloon pumping
§The number of patients missing Barthel index: ICU 2499, HDU 1529
aAdjusted HR adjusted for age, sex, Charlson comorbidity index, admission year, ambulance use, teaching hospitals, emergency charge, hospital beds, patients from nursing home, source of infection, drainage, surgery, mechanical ventilation, CRRT, PMX-DHP, VA-ECMO, use of two or more catecholamines, transfusions (red blood cell, platelet, fresh frozen plasma), albumin, globulin, sedatives drugs, opioids drugs, recombinant thrombomodulin, antithrombin III, and hydrocortisone
bAdjusted odds ratio adjusted for the same covariates as a
cRegression coefficient adjusted for the same covariates as a
Subgroup analysis and sensitivity analysis
| 30-day mortality | ||||||
|---|---|---|---|---|---|---|
| Number of events/number of patients (%)e | ||||||
| Overall | ICU | HDU | Adjusted HR | 95% CI | P value | |
| Subgroup analysis | ||||||
| Age, years | 0.71§ | |||||
| < 65 | 399/2149 (18.5) | 282/1479 (19.0) | 117/670 (17.4) | 0.92a | 0.74–1.13 | 0.440 |
| 65–74 | 607/2657 (22.8) | 376/1679 (22.3) | 231/978 (23.6) | 0.83a | 0.71–0.98 | 0.029 |
| 75–84 | 889/3679 (24.1) | 540/2213 (24.4) | 349/1466 (23.8) | 0.93a | 0.82–1.06 | 0.33 |
| ≥ 85 | 707/2333 (30.3) | 378/1213 (31.1) | 329/1120 (29.3) | 0.92a | 0.79–1.06 | 0.27 |
| Procedures | ||||||
| Mechanical ventilation | 1266/4049 (31.2) | 896/2986 (30.0) | 370/1063 (34.8) | 0.95b | 0.85–1.07 | 0.44 |
| CRRT | 500/1691 (29.5) | 403/1351 (29.8) | 97/340 (28.5) | 1.08b | 0.89–1.33 | 0.44 |
| PMX | 257/1025 (25.0) | 180/746 (24.1) | 77/279 (27.6) | 0.91b | 0.7–1.19 | 0.52 |
| VA-ECMO/IABP | 67/200 (33.5) | 51/172 (29.6) | 16/28 (57.1) | 0.35b | 0.17–0.69 | 0.002 |
| Source of infection | ||||||
| Respiratory disease | 442/1635 (27.0) | 239/971 (24.6) | 203/664 (30.5) | 0.86b | 0.71–1.03 | 0.1 |
| Urinary tract disease | 102/1136 (8.9) | 50/526 (9.5) | 52/610 (8.5) | 1.06b | 0.72–1.57 | 0.75 |
| Gastrointestinal disease | 379/1739 (21.7) | 278/1293 (21.5) | 101/446 (22.6) | 1.10b | 0.88–1.36 | 0.38 |
| Hepatobiliary disease | 128/848 (15.0) | 61/451 (13.5) | 67/397 (16.8) | 0.68b | 0.47–0.99 | 0.046 |
| Skin/soft tissue | 34/174 (19.5) | 26/123 (21.1) | 8/51 (15.6) | 1.63b | 0.72–3.71 | 0.23 |
| Sensitivity analysis | ||||||
| (a) population which include the patients who met the exclusion criteria | 2859/11699 (24.4) | 1759/7218 (24.3) | 1100/4481 (24.5) | 0.9c | 0.84–0.97 | 0.008 |
| (b) ICD-9 codes from the previous study supplemented with the corresponding ICD-10 codes | 3204/13816 (23.1) | 1965/8448 (23.2) | 1239/5368 (23.0) | 0.92c | 0.86–0.98 | 0.02 |
| (c) Hospital with ICUs and HDUs | 1997/8311 (24.0) | 1395/5798 (24.0) | 602/2513 (23.9) | 0.86c | 0.78–0.95 | 0.002 |
| (d) 14-day mortality | 1800/10818 (16.6) | 1068/6584 (16.2) | 732/4234 (17.2) | 0.88c | 0.82–0.95 | 0.002 |
| (e) In-hospital mortality | 3308/10818 (30.5) | 2041/6584 (31.0) | 1267/4234 (29.9) | 0.89c | 0.83–0.96 | 0.005 |
| (f) changing the definition of exposure and comparisond | ||||||
| (1) | 892/3539 (25.2) | 167/671 (24.8) | 725/2868 (25.2) | 1.02a | 0.86–1.21 | 0.78 |
| (2) | 589/2407 (24.4) | 167/671 (24.8) | 422/1736 (24.3) | 0.86a | 0.71–1.04 | 0.14 |
| (3) | 1147/4604 (24.9) | 725/2868 (25.2) | 422/1736 (24.3) | 0.88a | 0.77–1.00 | 0.052 |
| (g) propensity score-matched population | ||||||
| (1) caliper width of 0.1 of SD | 1598/6788 (23.5) | 746/3394 (21.9) | 852/3394 (25.1) | 0.89 | 0.82–0.97 | 0.013 |
| (2) caliper width of 0.2 of SD | 1765/7432 (23.7) | 840/3716 (22.6) | 925/3716 (24.8) | 0.91 | 0.84–0.99 | 0.03 |
CI confidence interval, SD standard deviation, CRRT continuous renal replacement therapy, PMX-DHP polymyxin B immobilized fiber column direct hemoperfusion, VA-ECMO venoatrial extracorporeal membrane oxygenation, IABP intra-aortic balloon pumping
§P for interaction
aAdjusted for sex, Charlson comorbidity index, admission year, ambulance use, teaching hospitals, emergency charge, hospital beds, patients from nursing home, source of infection, drainage, surgery, mechanical ventilation, CRRT, PMX-DHP, VA-ECMO, use of two or more catecholamines, transfusions (red blood cell, platelet, fresh frozen plasma), albumin, globulin, sedatives drugs, opioids drugs, recombinant thrombomodulin, antithrombin III, and hydrocortisone
bAdjusted for age and the same covariates as a. Among these, procedure and source of infection that fell into each subgroup were excluded from the covariates
cAdjusted for age and the same covariates as a
d(1) “ICU management fee 1” vs. “ICU management fee 3” and “Emergency and critical care unit management fee 2”, (2) “ICU management fee 1” vs. “Emergency and critical care unit management fee 1”, (3) “ICU management fee 3” and “Emergency and critical care unit management fee 2” vs. “Emergency and critical care unit management fee 1”
eThe "number of events" indicates deaths within 30 days of hospitalization, except for "14-days mortality," which indicates deaths within 14 days