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Titolo:
Predictors of mortality and resource utilization in cirrhotic patients admitted to the medical ICU
Autore:
Aggarwal, A; Ong, JP; Younossi, ZM; Nelson, DR; Hoffman-Hogg, L; Arroliga, AC;
Indirizzi:
Cleveland Clin Fdn, Sect Crit Care Med, Dept Pulm & Crit Care Med, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 re Med, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Gastroenterol, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 nterol, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Biostat, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 iostat, Cleveland, OH 44195 USA
Titolo Testata:
CHEST
fascicolo: 5, volume: 119, anno: 2001,
pagine: 1489 - 1497
SICI:
0012-3692(200105)119:5<1489:POMARU>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTENSIVE-CARE UNIT; LIVER-DISEASE; SURVIVAL; PROGNOSIS; SYSTEM; MODEL;
Keywords:
cirrhosis; cost; end-stage liver disease; intensive care; length of stay; mortality; outcome; resource utilization;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
18
Recensione:
Indirizzi per estratti:
Indirizzo: Arroliga, AC Cleveland Clin Fdn, Sect Crit Care Med, Dept Pulm & Crit CareMed, 9500 Euclid Ave,Desk G-62, Cleveland, OH 44195 USA Cleveland Clin Fdn9500 Euclid Ave,Desk G-62 Cleveland OH USA 44195
Citazione:
A. Aggarwal et al., "Predictors of mortality and resource utilization in cirrhotic patients admitted to the medical ICU", CHEST, 119(5), 2001, pp. 1489-1497

Abstract

Background and objective: Cirrhotic patients admitted to the medical ICU (MICU) are associated with high mortality rates and high resource utilization. This study identifies specific predictors of increased mortality and resource utilization and uses them to develop and validate prognostic models in cirrhotic patients admitted to the MICU. Methods: Cirrhotic patients admitted to the MICU were identified from the Critical Care Section database (January 1993 to October 1998). Clinical data were extracted from chart review including hospital course variables, mortality, and length of stay (LOS). Total cost per case (TCPC) was obtained from the Transition System Inc. Multivariate logistic and linear regression analyses identified the independent predictors of increased mortality and resource utilization used for model building (MB) and model validation (MV). Results: A total of 582 cases were randomized to the MB and MV groups. Each group contained 240 cases after exclusion criteria were applied. The MICUmortality rate was 36.6%, and the in-hospital mortality rate was 49.0%. Acute physiology, age, and chronic health evaluation (APACHE) III score (oddsratio [OR], 4.7; 95% confidence intel-val [CI], 2.70 to 8.16; p < 0.001), mechanical ventilation (OR, 4.57; 95% CI, 2.35 to 8.34); p < 0.001, and theuse of pressors (OR, 7.57; 95% CI, 4.35 to 13.18; p < 0.001) were independent predictors of MICU mortality. APACHE III score;(OR, 4.96; 95% CI, 2.97 to 8.29; p <less than> 0.001), the use of pressors (OR, 6.55; 95% CI, 3.66 to 11.72; p < 0.001), and acute renal failure(ARF) (OR, 4.31; 95% CI,2.41 to 7.71; p < 0.001) were independent predictors of in-hospital mortality. Increased LOS in the MICU was associated with mechanical ventilation, ARF, bronchoscopy, bacteremia, use of pressors, transjugular intrahepatic portosystemic shunt (TIPS), and never received cardiopulmonary resuscitation (CPR) (p <less than> 0.005). Source of admission, platelet transfusion, bacteremia, pneumonia, and never received CPR were independently associated with increased total LOS (p < 0.001). Mechanical ventilation, platelet transfusion,bronchoscopy, TIPS, sepsis, and never received CPR were independent predictors of increased TCPC (p < 0.001). Conclusion: Simple prognostic models for mortality and resource utilization have been developed for cirrhotic patients admitted to the MICU.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/12/20 alle ore 03:34:24