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中华重症医学电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 193 -197. doi: 10.3877/cma.j.issn.2096-1537.2020.02.018

所属专题: 文献

临床研究

酒精依赖与重症患者预后的回顾性队列研究
谢俊涛1,(), 陈钦桂2   
  1. 1. 423000 郴州市第一人民医院南院重症监护室
    2. 510080 广州,中山大学附属第一医院内科重症监护病房
  • 收稿日期:2020-01-05 出版日期:2020-05-28
  • 通信作者: 谢俊涛

Association between alcohol dependence and prognosis in critically ill patients: a retrospective cohort study

Juntao Xie1,(), Qingui Chen2   

  1. 1. Intensive Care Unit, South District, the First People′s Hospital of Chenzhou, Chenzhou 423000, China
    2. Medical Intensive Care Unit, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2020-01-05 Published:2020-05-28
  • Corresponding author: Juntao Xie
  • About author:
    Corresponding author: Xie Juntao, Email:
引用本文:

谢俊涛, 陈钦桂. 酒精依赖与重症患者预后的回顾性队列研究[J/OL]. 中华重症医学电子杂志, 2020, 06(02): 193-197.

Juntao Xie, Qingui Chen. Association between alcohol dependence and prognosis in critically ill patients: a retrospective cohort study[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(02): 193-197.

目的

探讨酒精依赖与重症患者的预后的关系。

方法

从一个可开放获取的国外重症电子临床数据库中选取重症住院患者,根据是否存在与酒精使用相关的诊断而判断其是否存在酒精依赖。利用Logistic回归和Cox回归模型校正潜在混杂因素并分析存在酒精依赖与重症患者预后(院内死亡、入院后28 d内死亡和入院后90 d内死亡)的关系。

结果

共纳入29 487例重症患者,所有患者均在入院后24 h内转入重症监护病房治疗。研究对象的平均年龄为(63.93±17.09)岁,其中7.77%(2292/29 487)的患者存在酒精依赖。在校正年龄、性别、所患疾病以及进入重症监护病房时的疾病严重程度评分等混杂因素后,存在酒精依赖是院内死亡的危险因素(比值比1.28,95%CI 1.05~1.57,P=0.0147),也是入院后28 d内死亡的危险因素(风险比1.25,95%CI 1.06~1.48,P=0.0092),但与入院后90 d内死亡无关联(风险比1.07,95%CI 0.93~1.23,P=0.3239)。

结论

存在酒精依赖可能是重症患者短期预后不良的独立危险因素。

Objective

To investigate whether alcohol dependence is associated with the prognosis of critically ill patients.

Methods

Critically ill patients were selected from a publicly accessible foreign critical care electronic database, and alcohol dependence was determined based on diagnoses related to alcohol abuse. Logistic regression and Cox regression models were used to adjust potential confounding factors and analyze the associations between alcohol dependence and prognosis of the critically ill patients including hospital mortality, 28-day mortality, and 90-day mortality after hospital admission.

Results

A total of 29 487 critically ill patients were included in the study. All patients were transferred to intensive care units within 24 h after hospital admission. The average age of the study population was (63.93±17.09) years, and 7.77% (2292/29 487) of them were alcohol-dependent. After adjusting for potential confounders mainly including age, sex, comorbidities, and disease severity scores when admitted to intensive care unit, alcohol dependence was found to be a risk factor for hospital mortality (odds ratio=1.28, 95% confidence interval: 1.05-1.57, P=0.0147), and 28-day mortality after admission (risk ratio=1.25, 95% confidence interval: 1.06-1.48, P=0.0092), but there was no statistically significant association with 90-day mortality after admission (risk ratio=1.07, 95% confidence interval: 0.93-1.23, P=0.3239).

Conclusion

Comorbid alcohol dependence might be an independent risk factor for poor short-term prognosis in critically ill patients.

表1 研究对象的基本资料
表2 基线特征以及预后在酒精依赖与非酒精依赖患者间的比较
变量 非酒精依赖患者(n=27 195) 酒精依赖患者(n=2292) 统计值 P
年龄(岁,±s 64.94±16.90 51.94±14.48 t=35.722 <0.001
男性 15009(55.19) 1744(76.09) χ2=376.347 <0.001
入院至进入ICU的间隔时间[h,MQUQL)] 0.05(0.00,0.91) 0.00(0.00,0.14) Z=18.620 <0.001
进入ICU当天SAPS II评分[MQUQL)] 33(25,42) 28(20,37) Z=16.475 <0.001
进入ICU当天需机械通气[例(%)] 12 980(47.73) 1096(47.82) χ2=0.007 0.935
进入ICU当天需肾脏替代治疗[例(%)] 767(2.82) 42(1.83) χ2=7.732 0.005
首次ICU的类型[例(%)] ? ? χ2=656.621 <0.001
? 内科ICU 8828(32.46) 1041(45.42) ? ?
? 心脏ICU 4091(15.04) 172(7.50) ? ?
? 心脏外科手术康复室 6396(23.52) 172(7.50) ? ?
? 外科ICU 4536(16.68) 355(15.49) ? ?
? 创伤/外科ICU 3344(12.30) 552(24.08) ? ?
合并脓毒症(ICD-9编码)[例(%)] 1771(6.51) 158(6.89) χ2=0.503 0.478
Elixhauser指数(SID30)[MQuQL)] 7(0,17) 7(0,18) χ2=1.360 0.174
主要诊断[例(%)] ? ? ? ?
? 脓毒症(ICD-9编码) 1486(5.46) 105(4.58) χ2=3.229 0.072
? 心脏瓣膜疾病 1674(6.16) 27(1.18) χ2=96.346 <0.001
? 急性心肌梗死 2332(8.58) 68(2.97) χ2=88.924 <0.001
? 冠心病或其他心脏疾病 2776(10.21) 66(2.88) χ2=130.343 <0.001
? 卒中 1626(5.98) 86(3.75) χ2=19.167 <0.001
? 颅内损伤 1055(3.88) 261(11.39) χ2=279.467 <0.001
结局指标[例(%)] ? ? ? ?
? 院内死亡 1863(6.85) 140(6.11) χ2=1.840 0.175
? 入院后28 d内死亡 2305(8.48) 158(6.89) χ2=6.913 0.009
? 入院后90 d内死亡 3840(14.12) 230(10.03) χ2=29.653 <0.001
总ICU内住院时间[d,MQUQL)] 2.60(1.62,4.87) 2.92(1.74,6.28) Z=7.253 <0.001
住院时间(d)[d,MQUQL)] 7.84(5.01,12.93) 8.50(4.73,15.57) Z=3.305 <0.001
图1 酒精依赖患者与非酒精依赖患者入院后28 d内的Kaplan-Meier生存曲线
表3 酒精依赖与重症患者院内死亡、入院后28 d或90 d内死亡的关联
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