Abstract：
BACKGROUND: Infectious diseases (ID) physicians are increasingly faced with the challenge of caring for patients with terminal illnesses or incurable infections.
METHODS: This was a retrospective cohort of all patients with an ID consult within an academic health system 1/1/2014 - 12/31/2023, including community, general, and transplant ID consult services.
RESULTS: There were 60,820 inpatient ID consults (17,235 community, 29,999 general, and 13,586 transplant) involving 37,848 unique patients. The number of consults increased by 94% and the rate rose from 5.0 to 9.9 consults per 100 inpatients (p<0.001). In total, 7.5% of patients receiving an ID consult died during admission, and 1,006 (2.6%) of patients were discharged to hospice. In-hospital mortality was 5.2% for community ID, 7.8% for general ID, and 10.7% for transplant ID patients (p<0.001). Six-month mortality was 9% for all non-obstetric admissions, , vs. 19% for community ID, 20.9% for general ID, and 22.3% for transplant ID.In total 2,866 (7.6%) of all patients receiving ID consultation also received palliative care consultation during the same hospitalization. The index ID consult preceded any palliative consult in the majority (69.5%) of cases. 16.3% of patients had a do-not-resuscitate order during the index hospitalization. 12.2% of all patients with a do-not-resuscitate order had this placed on the same day as the ID consult.
CONCLUSIONS: Patients receiving ID consultation were increasingly complex and more likely to die soon after consultation. These results provide a framework for ID clinicians to consider their role in end-of-life care.
METHODS: This was a retrospective cohort of all patients with an ID consult within an academic health system 1/1/2014 - 12/31/2023, including community, general, and transplant ID consult services.
RESULTS: There were 60,820 inpatient ID consults (17,235 community, 29,999 general, and 13,586 transplant) involving 37,848 unique patients. The number of consults increased by 94% and the rate rose from 5.0 to 9.9 consults per 100 inpatients (p<0.001). In total, 7.5% of patients receiving an ID consult died during admission, and 1,006 (2.6%) of patients were discharged to hospice. In-hospital mortality was 5.2% for community ID, 7.8% for general ID, and 10.7% for transplant ID patients (p<0.001). Six-month mortality was 9% for all non-obstetric admissions, , vs. 19% for community ID, 20.9% for general ID, and 22.3% for transplant ID.In total 2,866 (7.6%) of all patients receiving ID consultation also received palliative care consultation during the same hospitalization. The index ID consult preceded any palliative consult in the majority (69.5%) of cases. 16.3% of patients had a do-not-resuscitate order during the index hospitalization. 12.2% of all patients with a do-not-resuscitate order had this placed on the same day as the ID consult.
CONCLUSIONS: Patients receiving ID consultation were increasingly complex and more likely to die soon after consultation. These results provide a framework for ID clinicians to consider their role in end-of-life care.
摘要：
背景：传染病（ID）医生越来越面临照顾患有晚期疾病或无法治愈的感染的患者的挑战。
方法：这是一个回顾性队列研究，包括2014年1月1日至2023年12月31日在学术卫生系统内进行ID咨询的所有患者，包括社区，一般,和移植ID咨询服务。
结果：有60,820名住院患者ID咨询（17,235个社区，29,999一般，和13,586例移植），涉及37,848例独特患者。咨询次数增加了94%，比率从每100名住院患者5.0次上升到9.9次（p<0.001）。总的来说,接受身份咨询的患者中有7.5％在入院期间死亡，另有1,006名(2.6%)的病人出院到临终关怀医院。社区ID的住院死亡率为5.2％，普通身份证7.8%，移植ID患者为10.7%(p<0.001)。所有非产科入院的六个月死亡率为9%，,vs.19%为社区ID，一般身份证20.9%，移植ID为22.3%。在同一住院期间，总共有2,866名（7.6％）接受ID咨询的患者也接受了姑息治疗咨询。在大多数情况下（69.5％），索引ID咨询先于任何姑息性咨询。16.3％的患者在住院期间有不复苏的顺序。在所有接受不复苏命令的患者中，有12.2％在ID咨询的同一天放置了此命令。
结论：接受身份咨询的患者越来越复杂，更有可能在咨询后很快死亡。这些结果为ID临床医生提供了一个框架，以考虑他们在临终关怀中的作用。
方法：这是一个回顾性队列研究，包括2014年1月1日至2023年12月31日在学术卫生系统内进行ID咨询的所有患者，包括社区，一般,和移植ID咨询服务。
结果：有60,820名住院患者ID咨询（17,235个社区，29,999一般，和13,586例移植），涉及37,848例独特患者。咨询次数增加了94%，比率从每100名住院患者5.0次上升到9.9次（p<0.001）。总的来说,接受身份咨询的患者中有7.5％在入院期间死亡，另有1,006名(2.6%)的病人出院到临终关怀医院。社区ID的住院死亡率为5.2％，普通身份证7.8%，移植ID患者为10.7%(p<0.001)。所有非产科入院的六个月死亡率为9%，,vs.19%为社区ID，一般身份证20.9%，移植ID为22.3%。在同一住院期间，总共有2,866名（7.6％）接受ID咨询的患者也接受了姑息治疗咨询。在大多数情况下（69.5％），索引ID咨询先于任何姑息性咨询。16.3％的患者在住院期间有不复苏的顺序。在所有接受不复苏命令的患者中，有12.2％在ID咨询的同一天放置了此命令。
结论：接受身份咨询的患者越来越复杂，更有可能在咨询后很快死亡。这些结果为ID临床医生提供了一个框架，以考虑他们在临终关怀中的作用。
