DOI QR코드

DOI QR Code

The Prognostic Value of the Charlson's Comorbidity Index in Patients with Prolonged Acute Mechanical Ventilation: A Single Center Experience

  • Song, Seung Eon (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Sang Hee (Division of Pulmonology, Department of Internal Medicine, Wonkwang University Sanbon Hospital) ;
  • Jo, Eun-Jung (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Eom, Jung Seop (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Mok, Jeong Ha (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Mi-Hyun (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ki Uk (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Min Ki (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Kwangha (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine)
  • Received : 2015.12.14
  • Accepted : 2016.08.10
  • Published : 2016.10.05

Abstract

Background: The aim of our study was to evaluate the prognostic value of Charlson's weighted index of comorbidities (WIC) in patients with prolonged acute mechanical ventilation (PAMV, ventilator care ${\geq}96$ hours). Methods: We retrospectively enrolled 299 Korean PAMV patients who were admitted in a medical intensive care unit (ICU) of a university-affiliated tertiary care hospital between 2008 and 2013. Survivors were defined as patients who survived for 60 days after ICU admission. Results: The patients' mean age was $65.1{\pm}14.1$ years and 70.6% were male. The mean ICU and hospital length of stay was $21.9{\pm}19.7$ and $39.4{\pm}39.1$ days, respectively. In addition, the 60-day mortality rate after ICU admission was 35.5%. The mean WIC was $2.3{\pm}1.8$, with significant differences between nonsurvivors and survivors ($2.7{\pm}2.1$ vs. $2.1{\pm}1.7$, p<0.05). The area under the curve of receiver-operating-characteristics curve for WIC was 0.593 (95% confidence interval [CI], 0.523-0.661; p<0.05). Based on Kaplan-Meier curves of 60-day survival, WIC ${\geq}5$ had statistically lower survival than WIC <5 (logrank test, p<0.05). In a multivariate Cox proportional hazard model, WIC ${\geq}5$ was associated with poor prognosis (hazard ratio, 1.901; 95% CI, 1.140-3.171; p<0.05). The mortality rate of patients with WIC ${\geq}5$ was 54.2%. Conclusion: Our study showed a WIC score ${\geq}5$ might be helpful in predicting 60-day mortality in PAMV patients.

Keywords

References

  1. Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med 2010;38:65-71. https://doi.org/10.1097/CCM.0b013e3181b090d0
  2. Zilberberg MD, Luippold RS, Sulsky S, Shorr AF. Prolonged acute mechanical ventilation, hospital resource utilization, and mortality in the United States. Crit Care Med 2008;36:724-30. https://doi.org/10.1097/CCM.0B013E31816536F7
  3. Kale MS, Bishop TF, Federman AD, Keyhani S. "Top 5" lists top $5 billion. Arch Intern Med 2011;171:1856-8. https://doi.org/10.1001/archinternmed.2011.424
  4. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA 2012;307:1513-6. https://doi.org/10.1001/jama.2012.362
  5. Garland A, Shaman Z, Baron J, Connors AF Jr. Physicianattributable differences in intensive care unit costs: a singlecenter study. Am J Respir Crit Care Med 2006;174:1206-10. https://doi.org/10.1164/rccm.200511-1810OC
  6. Campbell EG, Regan S, Gruen RL, Ferris TG, Rao SR, Cleary PD, et al. Professionalism in medicine: results of a national survey of physicians. Ann Intern Med 2007;147:795-802. https://doi.org/10.7326/0003-4819-147-11-200712040-00012
  7. Zilberberg MD, de Wit M, Pirone JR, Shorr AF. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery. Crit Care Med 2008;36:1451-5. https://doi.org/10.1097/CCM.0b013e3181691a49
  8. Zilberberg MD, Shorr AF. Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: implications for budgets, plant and personnel planning. BMC Health Serv Res 2008;8:242. https://doi.org/10.1186/1472-6963-8-242
  9. Zilberberg MD, Kramer AA, Higgins TL, Shorr AF. Prolonged acute mechanical ventilation: implications for hospital benchmarking. Chest 2009;135:1157-62. https://doi.org/10.1378/chest.08-1928
  10. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. https://doi.org/10.1016/0021-9681(87)90171-8
  11. Norena M, Wong H, Thompson WD, Keenan SP, Dodek PM. Adjustment of intensive care unit outcomes for severity of illness and comorbidity scores. J Crit Care 2006;21:142-50. https://doi.org/10.1016/j.jcrc.2005.11.011
  12. Quach S, Hennessy DA, Faris P, Fong A, Quan H, Doig C. A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients. BMC Health Serv Res 2009;9:129. https://doi.org/10.1186/1472-6963-9-129
  13. Yang Y, Yang KS, Hsann YM, Lim V, Ong BC. The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis. J Crit Care 2010;25:398-405. https://doi.org/10.1016/j.jcrc.2009.09.001
  14. Oltean S, Tatulescu D, Bondor C, Slavcovici A, Cismaru C, Lupse M, et al. Charlson's weighted index of comorbidities is useful in assessing the risk of death in septic patients. J Crit Care 2012;27:370-5. https://doi.org/10.1016/j.jcrc.2011.08.021
  15. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29. https://doi.org/10.1097/00003246-198510000-00009
  16. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. https://doi.org/10.1007/BF01709751
  17. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;342:1301-8. https://doi.org/10.1056/NEJM200005043421801
  18. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228. https://doi.org/10.1007/s00134-012-2769-8
  19. Poses RM, McClish DK, Smith WR, Bekes C, Scott WE. Prediction of survival of critically ill patients by admission comorbidity. J Clin Epidemiol 1996;49:743-7. https://doi.org/10.1016/0895-4356(96)00021-2
  20. Johnston JA, Wagner DP, Timmons S, Welsh D, Tsevat J, Render ML. Impact of different measures of comorbid disease on predicted mortality of intensive care unit patients. Med Care 2002;40:929-40. https://doi.org/10.1097/00005650-200210000-00010
  21. Ladha KS, Zhao K, Quraishi SA, Kurth T, Eikermann M, Kaafarani HM, et al. The Deyo-Charlson and Elixhauser-van Walraven Comorbidity Indices as predictors of mortality in critically ill patients. BMJ Open 2015;5:e008990. https://doi.org/10.1136/bmjopen-2015-008990
  22. Kim JH, Hong SK, Kim KC, Lee MG, Lee KM, Jung SS, et al. Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units. J Crit Care 2012;27:414.
  23. Phua J, Koh Y, Du B, Tang YQ, Divatia JV, Tan CC, et al. Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ 2011;342:d3245. https://doi.org/10.1136/bmj.d3245
  24. Kwak SH, Jeong CW, Lee SH, Lee HJ, Koh Y. Current status of intensive care units registered as critical care subspecialty training hospitals in Korea. J Korean Med Sci 2014;29:431-7. https://doi.org/10.3346/jkms.2014.29.3.431
  25. Lee SH, Kim MJ, Jeong ES, Jo EJ, Eom JS, Mok JH, et al. Outcomes and prognostic factors in patients with prolonged acute mechanical ventilation: a single-center study in Korea. J Crit Care 2015;30:1016-20. https://doi.org/10.1016/j.jcrc.2015.05.020

Cited by

  1. Better ICU Management by Analysis of Clinical Profile and Outcomes of Neuro-Critical Patients in Neurocritical Care Unit vol.5, pp.1, 2018, https://doi.org/10.5812/archneurosci.61648
  2. Regular follow-up visits reduce the risk for asthma exacerbation requiring admission in Korean adults with asthma vol.14, pp.None, 2016, https://doi.org/10.1186/s13223-018-0250-0
  3. Analysis of patient factors associated with 30‐day mortality after tracheostomy vol.129, pp.4, 2016, https://doi.org/10.1002/lary.27345
  4. Effect of Early Tracheostomy on Clinical Outcomes in Patients with Prolonged Acute Mechanical Ventilation: A Single-Center Study vol.83, pp.2, 2020, https://doi.org/10.4046/trd.2019.0082
  5. Frequent Outpatient Visits Prevent Exacerbation of Chronic Obstructive Pulmonary Disease vol.10, pp.None, 2016, https://doi.org/10.1038/s41598-020-63064-x
  6. Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study vol.11, pp.1, 2021, https://doi.org/10.1038/s41598-021-96762-1