澳大利亚和新西兰慢性危重症儿童的 5 年生存率。
Five-Year Survival of Children With Chronic Critical Illness in Australia and New Zealand.
机构信息
1Department of Paediatric Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia. 2Murdoch Children's Research Institute, Melbourne, VIC, Australia. 3Australia and New Zealand Paediatric Intensive Care Registry, Brisbane, QLD, Australia. 4Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia. 5Paediatric Intensive Care Unit, Princess Margaret Hospital, Perth, WA, Australia. 6Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia. 7Paediatric Intensive Care Unit, Children's Hospital at Westmead, Sydney, NSW, Australia. 8Paediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia. 9Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand. 10Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland. 11Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia. 12Paediatric Intensive Care Unit, Sydney Children's Hospital, Sydney, NSW, Australia.
出版信息
Crit Care Med. 2015 Sep;43(9):1978-85. doi: 10.1097/CCM.0000000000001076.
OBJECTIVE
Outcomes for children with chronic critical illness are not defined. We examined the long-term survival of these children in Australia and New Zealand.
DESIGN
All cases of PICU chronic critical illness with length of stay more than 28 days and age 16 years old or younger in Australia and New Zealand from 2000 to 2011 were studied. Five-year survival was analyzed using Kaplan-Meir estimates, and risk factors for mortality evaluated using Cox regression.
SETTING
All PICUs in Australia and New Zealand.
PATIENTS
Nine hundred twenty-four children with chronic critical illness.
INTERVENTION
None.
MEASUREMENTS AND MAIN RESULTS
Nine hundred twenty-four children were admitted to PICU for longer than 28 days on 1,056 occasions, accounting for 1.3% of total admissions and 23.5% of bed days. Survival was known for 883 of 924 patients (95.5%), with a median follow-up of 3.4 years. The proportion with primary cardiac diagnosis increased from 27% in 2000-2001 to 41% in 2010-2011. Survival was 81.4% (95% CI, 78.6-83.9) to PICU discharge, 70% (95% CI, 66.7-72.8) at 1 year, and 65.5% (95% CI, 62.1-68.6) at 5 years. Five-year survival was 64% (95% CI, 58.7-68.6) for children admitted in 2000-2005 and 66% (95% CI, 61.7-70) if admitted in 2006-2011 (log-rank test, p = 0.37). After adjusting for admission severity of illness using the Paediatric Index of Mortality 2 score, predictors for 5-year mortality included bone marrow transplant (hazard ratio, 3.66; 95% CI, 2.26-5.92) and single-ventricle physiology (hazard ratio, 1.98; 95% CI, 1.37-2.87). Five-year survival for single-ventricle physiology was 47.2% (95% CI, 34.3-59.1) and for bone marrow transplantation 22.8% (95% CI, 8.7-40.8).
CONCLUSIONS
Two thirds of children with chronic critical illness survive for at-least 5 years, but there was no improvement between 2000 and 2011. Cardiac disease constitutes an increasing proportion of pediatric chronic critical illness. Bone marrow transplant recipients and single-ventricle physiology have the poorest outcomes.
目的
儿童慢性危重病的预后尚不清楚。我们研究了澳大利亚和新西兰儿童慢性危重病的长期生存情况。
设计
纳入了 2000 年至 2011 年期间澳大利亚和新西兰所有 ICU 慢性危重病住院时间超过 28 天且年龄在 16 岁以下的患儿。使用 Kaplan-Meier 估计法分析 5 年生存率，使用 Cox 回归分析死亡率的危险因素。
地点
澳大利亚和新西兰所有 PICUs。
患者
924 名患有慢性危重病的儿童。
干预措施
无。
测量和主要结果
924 名患儿因病情需要在 ICU 住院超过 28 天，共 1056 次，占总住院人数的 1.3%，占住院总天数的 23.5%。924 名患儿中 883 名（95.5%）的生存情况已知，中位随访时间为 3.4 年。2000-2001 年首次诊断为原发性心脏病的患儿比例为 27%，而 2010-2011 年则增至 41%。至 ICU 出院时的生存率为 81.4%（95%可信区间，78.6%-83.9%），1 年时为 70%（95%可信区间，66.7%-72.8%），5 年时为 65.5%（95%可信区间，62.1%-68.6%）。2000-2005 年入院的患儿 5 年生存率为 64%（95%可信区间，58.7%-68.6%），而 2006-2011 年入院的患儿 5 年生存率为 66%（95%可信区间，61.7%-70%）（对数秩检验，p=0.37）。使用儿科死亡率 2 评分校正入院严重程度后，5 年死亡率的预测因素包括骨髓移植（风险比，3.66；95%可信区间，2.26-5.92）和单心室生理（风险比，1.98；95%可信区间，1.37-2.87）。单心室生理患儿 5 年生存率为 47.2%（95%可信区间，34.3%-59.1%），骨髓移植患儿为 22.8%（95%可信区间，8.7%-40.8%）。
结论
三分之二的慢性危重病患儿至少存活 5 年，但 2000 年至 2011 年期间没有改善。心脏病构成了儿科慢性危重病的比例不断增加的一部分。骨髓移植和单心室生理的患儿预后最差。
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