电惊厥疗法(ECT)用于治疗严重的精神疾病,并与严重抑郁症患者的自杀风险和全因死亡率降低有关。我们调查了ECT后不久发生的死亡原因,并确定了医学死亡原因的潜在危险因素。
2012年至2018年接受ECT治疗的患者被纳入这项基于瑞典注册的研究。使用多变量二元逻辑回归计算协变量的比值比,以确定30天死亡率的潜在预测因子。
在20,225名患者中,93例(0.46%)死于自杀,123例(0.61%)死于医疗原因。心血管疾病是最常见的医学死亡原因(n=49,40%)。年纪大了,Charlson合并症指数为1或以上,心房颤动,肾病,反流病,痴呆症,和癌症与医疗原因导致的死亡风险增加有关。
基于注册数据的现实生活中的观察性研究可能显示出关联,但不能确定因果关系。如果有医疗记录,我们就能更好地确定死亡是否是由ECT引起的,麻醉,预先存在的医疗条件,或者精神障碍。
ECT似乎是一种低风险的医疗程序。患有严重躯体疾病的老年人死亡风险最高,应考虑采取额外措施,以在ECT前检查期间优化其医疗健康,在ECT期间和之后。
Electroconvulsive therapy (ECT) is used to treat severe psychiatric disorders and is associated with reduced risk of suicide and all-cause mortality in patients with severe depression. We investigated the causes of death occurring shortly after ECT and identified potential risk factors for medical causes of death.
Patients treated with ECT between 2012 and 2018 were included in this Swedish register-based study. Multivariate binary logistic regression was used to calculate odds ratios for covariates to determine potential predictors of 30-day mortality.
Of the 20,225 included patients, 93 (0.46 %) died of suicide and 123 (0.61 %) died of medical causes after ECT. Cardiovascular disease was the most common medical cause of death (n = 49, 40 %). An older age, a Charlson Comorbidity Index of 1 or more, atrial fibrillation, kidney disease, reflux disease, dementia, and cancer were associated with increased risk of death by medical causes.
Real-life observational studies based on registry data may demonstrate associations, but cannot determine causality. If medical records had been available, we would be better able to determine if deaths were due to the ECT, anesthesia, pre-existing medical conditions, or the mental disorder.
ECT appears to be a low-risk medical procedure. Older individuals with severe somatic diseases have the highest risk of death and extra measures should be considered to optimize their medical health during the pre-ECT workup, and during and after ECT.