Readmission to Medical Intensive Care Units: Risk Factors and Prediction
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Purpose: The objectives of this study were to find factors related to medical intensivecare unit (ICU) readmission and to develop a prediction index for determining patients who are likely to be readmitted to medical ICUs. Materials and Methods: We performed a retrospective cohort study of 343 consecutive patients who were admittedto the medical ICU of a single medical center from January 1, 2008 to December31, 2012. We analyzed a broad range of patients’ characteristics on the day of admission, extubation, and discharge from the ICU. Results: Of the 343 patients discharged from the ICU alive, 33 (9.6%) were readmitted to the ICU unexpectedly. Using logistic regression analysis, the verified factors associated with increased risk of ICU readmission were male sex [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.29‒8.48], history of diabetes mellitus (OR 3.03, 95% CI 1.29‒7.09), applicationof continuous renal replacement therapy during ICU stay (OR 2.78, 95% CI 0.85‒9.09), white blood cell count on the day of extubation (OR 1.13, 95% CI 1.07‒1.21), and heart rate just before ICU discharge (OR 1.03, 95% CI 1.01‒1.06). We established a prediction index for ICU readmission using the five verified risk factors (area under the curve, 0.76, 95% CI 0.66‒0.86). Conclusion: By using specificrisk factors associated with increased readmission to the ICU, a numerical index could be established as an estimation tool to predict the risk of ICU readmission.
Abstract
Purpose: The objectives of this study were to find factors related to medical intensivecare unit (ICU) readmission and to develop a prediction index for determining patients who are likely to be readmitted to medical ICUs. Materials and Methods: We performed a retrospective cohort study of 343 consecutive patients who were admittedto the medical ICU of a single medical center from January 1, 2008 to December31, 2012. We analyzed a broad range of patients’ characteristics on the day of admission, extubation, and discharge from the ICU. Results: Of the 343 patients discharged from the ICU alive, 33 (9.6%) were readmitted to the ICU unexpectedly. Using logistic regression analysis, the verified factors associated with increased risk of ICU readmission were male sex [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.29‒8.48], history of diabetes mellitus (OR 3.03, 95% CI 1.29‒7.09), applicationof continuous renal replacement therapy during ICU stay (OR 2.78, 95% CI 0.85‒9.09), white blood cell count on the day of extubation (OR 1.13, 95% CI 1.07‒1.21), and heart rate just before ICU discharge (OR 1.03, 95% CI 1.01‒1.06). We established a prediction index for ICU readmission using the five verified risk factors (area under the curve, 0.76, 95% CI 0.66‒0.86). Conclusion: By using specificrisk factors associated with increased readmission to the ICU, a numerical index could be established as an estimation tool to predict the risk of ICU readmission.
참고문헌 (19)
- Metnitz PG, "Critically ill patients readmitted to intensive care units--lessons to learn?", Intensive Care Med, 29, pp.241~248 (2003)
- Renton J, "Factors associated with increased risk of readmission to intensive care in Australia", Intensive Care Med, 37, pp.1800~1808 (2011)
- Rosenberg AL, "Who bounces back? Physiologic and other predictors of intensive care unit readmission", Crit Care Med, 29, pp.511~518 (2001)
- Rosenberg AL, "Patients readmitted to ICUs*: a systematic review of risk factors and outcomes", Chest, 118, pp.492~502 (2000)
- Capuzzo M, "Admission and discharge of critically ill patients", Curr Opin Crit Care, 16, pp.499~504 (2010)
- Heidegger CP, "A nationwide survey of intensive care unit discharge practices", Intensive Care Med, 31, pp.1676~1682 (2005)
- Skowronski GA, "Bed rationing and allocation in the intensive care unit", Curr Opin Crit Care, 7, pp.480~484 (2001)
- Kramer AA, "Intensive care unit readmissions in U.S. hospitals: patient characteristics, risk factors, and outcomes", Crit Care Med, 40, pp.3~10 (2012)
- Chrusch CA, "High occupancy increases the risk of early death or readmission after transfer from intensive care", Crit Care Med, 37, pp.2753~2758 (2009)
- Gajic O, "The Stability and Workload Index for Transfer score predicts unplanned intensive care unit patient readmission: initial development and validation", Crit Care Med, 36, pp.676~682 (2008)
- Campbell AJ, "Predicting death and readmission after intensive care discharge", Br J Anaesth, 10, pp.656~662 (2008)
- Fernandez R, "Ward mortality after ICU discharge : a multicenter validation of the Sabadell score", Intensive Care Med, 36, pp.1196~1201 (2010)
- Reini K, "The prognostic value of the Modified Early Warning Score in critically ill patients: a prospective, observational study", Eur J Anaesthesiol, 29, pp.152~157 (2012)
- Badawi O, "Readmissions and death after ICU discharge: development and validation of two predictive models", PLoS One, 7, pp.e48758~ (2012)
- Fernandez R, "A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score", Crit Care, 10, pp.R179~ (2006)
- Ouanes I, "A model to predict short-term death or readmission after intensive care unit discharge", J Crit Care, 27, pp.422~ (2012)
- Hosein FS, "A systematic review of tools for predicting severe adverse events following patient discharge from intensive care units", Crit Care, 17, pp.R102~ (2013)
- Frost SA, "Severity of illness and risk of readmission to intensive care: a meta-analysis", Resuscitation, 80, pp.505~510 (2009)
- Kaben A, "Readmission to a surgical intensive care unit: incidence, outcome and risk factors", Crit Care, 12, pp.R123~ (2008)