背景:我们评估了生命体征和实验室测试的生理参数与住院死亡率的关系,即使在重症监护环境中,也要关注不寻常或极端的价值观。
方法:我们回顾性研究了PhilipsHealthcare-MITeICU数据(207家美国医院,20142015),包括166,959名成人患者重症监护入院。分析在第一个入院日测量的最疯狂(最差)值,我们调查了生命体征(体温,心率,平均动脉压,和呼吸频率)以及白蛋白,胆红素,通过动脉血气(ABG)的血液pH值,血尿素氮,肌酐,FiO2ABG,葡萄糖,血细胞比容,PaO2ABG,PaCO2ABG,钠,24小时尿量,和白细胞计数(WBC)。
结果:在极端低血液pH值下,院内死亡率≥50%,体温低和高,低白蛋白,低葡萄糖,心率低。血液酸碱度接近极端,温度,葡萄糖,心率,PaO2,WBC,相对而言。测量值的微小变化与死亡率增加几倍相关。然而,高死亡率和突然的死亡率增加通常被阈值或分类生理参数的常见做法所掩盖。住院死亡率的最佳预测因素是血液pH值,温度,和FiO2(定标Brier评分:分别为0.084、0.063和0.049)。
结论:院内死亡率很高,并且在血液pH值极端时急剧增加,体温,和其他参数。常见的阈值化掩盖了这些关联。在实践中,生命体征有时比实验室测试的参数更随意。然而,生命体征更容易获得,我们发现它们通常是最好的死亡率预测因子,支持生命体征被低估的观点。
BACKGROUND: We evaluated relationships of vital signs and laboratory-tested physiological parameters with in-hospital mortality, focusing on values that are unusual or extreme even in critical care settings.
METHODS: We retrospectively studied Philips Healthcare-MIT eICU data (207 U.S. hospitals, 20142015), including 166,959 adult-patient critical care admissions. Analyzing most-deranged (worst) value measured in the first admission day, we investigated vital signs (body temperature, heart rate, mean arterial pressure, and respiratory rate) as well as albumin, bilirubin, blood pH via arterial blood gas (ABG), blood urea nitrogen, creatinine, FiO2 ABG, glucose, hematocrit, PaO2 ABG, PaCO2 ABG, sodium, 24-hour urine output, and white blood cell count (WBC).
RESULTS: In-hospital mortality was ≥50% at extremes of low blood pH, low and high body temperature, low albumin, low glucose, and low heart rate. Near extremes of blood pH, temperature, glucose, heart rate, PaO2 , and WBC, relatively. Small changes in measured values correlated with several-fold mortality rate increases. However, high mortality rates and abrupt mortality increases were often hidden by the common practice of thresholding or binning physiological parameters. The best predictors of in-hospital mortality were blood pH, temperature, and FiO2 (scaled Brier scores: 0.084, 0.063, and 0.049, respectively).
CONCLUSIONS: In-hospital mortality is high and sharply increasing at extremes of blood pH, body temperature, and other parameters. Common-practice thresholding obscures these associations. In practice, vital signs are sometimes treated more casually than laboratory-tested parameters. Yet, vitals are easier to obtain and we found they are often the best mortality predictors, supporting perspectives that vitals are undervalued.