Development of a Prognostic Scoring System for Tracheostomized Patients Requiring Prolonged Ventilator Care: A Ten-Year Experience in a University-Affiliated Tertiary Hospital
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Selection
2.2. Outcome and Data Collection
2.3. ProVent 14 Scores and Additional Variables
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Analysis of Tracheostomized Patients
3.3. Prognostic Model for 1-Year Mortality in Tracheostomized Patients
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Tracheostomy (n = 278) | Non-Tracheostomy (n = 49) | p-Value |
---|---|---|---|
Age, years | 71 (61–77) | 64 (54–76) | 0.711 |
Male, n (%) | 184 (66.2) | 33 (67.3) | 0.874 |
Body mass index (kg/m2) 1 | 22.0 (19.8–24.0) | 22.0 (19.6–25.9) | 0.480 |
Major diagnoses leading to MV, n (%) | |||
Pulmonary including pneumonia | 204 (73.4) | 34 (69.4) | 0.563 |
Neurologic diseases | 26 (9.4) | 3 (6.1) | 0.463 |
Infectious diseases other than pneumonia | 22 (7.9) | 8 (16.3) | 0.060 |
Postoperative state | 7 (2.5) | 2 (4.1) | 0.537 |
Trauma | 5 (1.8) | 0 (0.0) | 0.344 |
Cardiovascular diseases | 4 (1.4) | 0 (0.0) | 0.398 |
Others, n (%) 2 | 10 (3.6) | 2 (4.1) | 0.868 |
Severity of illness | |||
APACHE II score | 20 (15.0–25.0) | 20 (15–26) | 0.366 |
SOFA score | 7 (4.0–9.0) | 9 (5–11) | 0.041 |
Charlson’s comorbidity index | 4 (3–6) | 5 (3–6) | 0.046 |
MV length of stay, days | 25 (19–35) | 17 (15–22) | 0.238 |
Hospital length of stay, days | 41.0 (27.0–69.3) | 27.0 (17.5–46.0) | 0.291 |
ICU length of stay, days | 27.0 (20.0–39.3) | 20.0 (16.0–24.0) | 0.523 |
Mortality, n (%) | |||
ICU mortality | 104 (37.4) | 31 (63.3) | 0.001 |
In-hospital mortality | 113 (40.6) | 32 (65.3) | 0.001 |
1-year cumulative mortality | 180 (64.7) | 41 (83.7) | 0.009 |
Variable | Survivors (n = 98) | Non-Survivors (n = 180) | p-Value |
---|---|---|---|
Age ≥ 65 years | 56 (57.1) | 130 (72.2) | 0.011 |
Clinical variables on day 14 of MV | |||
Requirement for vasopressors, n (%) | 23 (23.5) | 72 (40.0) | 0.005 |
Requirement for hemodialysis, n (%) | 5 (5.1) | 25 (13.9) | 0.024 |
Occurrence of delirium, n (%) | 11 (11.2) | 12 (6.7) | 0.188 |
Laboratory data on day 14 of MV | |||
Platelet count < 150 × 109 /L, n (%) | 22 (22.4) | 96 (53.3) | <0.001 |
Leukocytosis, n (%) | 33 (33.7) | 80 (44.4) | 0.081 |
PaO2/FiO2 < 200 mmHg, n (%) | 17 (17.3) | 67 (37.2) | 0.001 |
Albumin | 2.7 (2.4–3.0) | 2.5 (2.3–2.9) | 0.002 |
Bilirubin | 0.7 (0.4–1.1) | 0.9 (0.5–1.7) | 0.004 |
Underlying comorbidities, n (%) | |||
Diabetes mellitus | 32 (32.7) | 59 (32.8) | 0.983 |
Cardiovascular diseases | 14 (14.3) | 62 (34.4) | <0.001 |
Chronic lung diseases | 16 (16.3) | 49 (27.2) | 0.040 |
Neurologic diseases | 28 (28.6) | 36 (20) | 0.105 |
Hemato-oncologic diseases | 11 (11.2) | 49 (27.2) | 0.002 |
Chronic kidney diseases | 5 (5.1) | 27 (15) | 0.013 |
Immunocompromised | 2 (2.0) | 25 (13.9) | 0.001 |
Chronic liver diseases | 11 (11.2) | 15 (8.3) | 0.429 |
Rheumatologic diseases | 2 (2) | 7 (3.9) | 0.406 |
Variable | Unadjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value | β Value |
---|---|---|---|---|---|
Age ≥ 65 years | 1.950 (1.164–3.267) | 0.011 | |||
BMI ≤ 23.0 kg/m2 | 2.159 (1.295–3.597) | 0.003 | 2.145 (1.184–3.887) | 0.012 | 0.763 |
Clinical variables on day 14 of ventilator care | |||||
Requirement for vasopressors | 2.174 (1.249–3.784) | 0.006 | |||
Requirement for hemodialysis | 3.000 (1.110–8.106) | 0.030 | |||
Laboratory data on day 14 of ventilator care | |||||
Platelet count < 150 × 103/μL | 3.948 (2.261–6.895) | <0.001 | 3.256 (1.736–6.106) | <0.001 | 1.180 |
Leukocytosis | 1.576 (0.945–2.629) | 0.082 | |||
PaO2/FiO2 ≤ 200 mmHg | 2.825 (1.544–5.168) | 0.001 | 2.953 (1.488–5.862) | 0.002 | 1.083 |
Albumin ≤ 2.8 g/dL | 2.277 (1.353–3.834) | 0.002 | 1.888 (1.016–3.510) | 0.044 | 0.636 |
Underlying comorbidities | |||||
Cardiovascular diseases | 3.153 (1.656–6.002) | <0.001 | 2.945 (1.396–6.212) | 0.005 | 1.080 |
Chronic lung diseases | 1.917 (1.023–3.593) | 0.042 | |||
Hemato-oncologic diseases | 2.958 (1.458–6.005) | 0.003 | |||
Chronic kidney diseases | 3.282 (1.222–8.820) | 0.018 | |||
Immunocompromised | 7.742 (1.793–33.423) | 0.006 | 8.934 (1.898–42.055) | 0.006 | 2.190 |
Variable | Unadjusted OR (95% CI) | p-Value |
---|---|---|
Age ≥ 65 years | 1.750 (0.369–8.302) | 0.481 |
Clinical variables on day 14 of MV | ||
Requirement for vasopressors | 2.604 (0.546–12.428) | 0.230 |
Requirement for hemodialysis | 0.618 (0.103–3.719) | 0.599 |
Laboratory data on day 14 of MV | ||
Platelet count < 150 × 109 /L | 5.200 (0.929–29.094) | 0.061 |
Leukocytosis | 0.640 (0.140–2.930) | 0.565 |
Underlying comorbidities, n (%) | ||
Cardiovascular diseases | 2.897 (0.321–26.158) | 0.344 |
Chronic kidney diseases | 1.321 (0.128–13.656) | 0.815 |
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Jang, H.; Yoo, W.; Seong, H.; Kim, S.; Kim, S.H.; Jo, E.-J.; Eom, J.S.; Lee, K. Development of a Prognostic Scoring System for Tracheostomized Patients Requiring Prolonged Ventilator Care: A Ten-Year Experience in a University-Affiliated Tertiary Hospital. Medicina 2024, 60, 280. https://doi.org/10.3390/medicina60020280
Jang H, Yoo W, Seong H, Kim S, Kim SH, Jo E-J, Eom JS, Lee K. Development of a Prognostic Scoring System for Tracheostomized Patients Requiring Prolonged Ventilator Care: A Ten-Year Experience in a University-Affiliated Tertiary Hospital. Medicina. 2024; 60(2):280. https://doi.org/10.3390/medicina60020280
Chicago/Turabian StyleJang, Hyojin, Wanho Yoo, Hayoung Seong, Saerom Kim, Soo Han Kim, Eun-Jung Jo, Jung Seop Eom, and Kwangha Lee. 2024. "Development of a Prognostic Scoring System for Tracheostomized Patients Requiring Prolonged Ventilator Care: A Ten-Year Experience in a University-Affiliated Tertiary Hospital" Medicina 60, no. 2: 280. https://doi.org/10.3390/medicina60020280