Factors associated with prolonged intensive care stay among self-poisoned patients

Since recovery or death is generally observed within a few days after intensive care unit (ICU) admission of self-poisoned patients in the developed countries, reasons for the prolonged ICU stay are of interest as they have been poorly investigated. We aimed to identify the characteristics, risk factors, outcome, and predictors of death in self-poisoned patients requiring prolonged ICU management. We conducted an eight-year single-center cohort study including all self-poisoned patients who stayed at least seven days in the ICU. Patients admitted with drug adverse events and chronic overdoses were excluded. Using multivariate analyses, we investigated risk factors for prolonged ICU stay in comparison with a group of similar size of self-poisoned patients with Among 2,963 poisoned patients admitted in the ICU during the study period, the number who stayed beyond seven days was small (398/2,963, 13.1%), including 239 self-poisoned patients (125 F/114M; age, 51 years [38–65] (median [25th-75th percentiles]); SAPSII, 56 [43–69]). Involved toxicants included psychotropic drugs (59%), cardiotoxicants (31%), opioids (15%) and street drugs (13%). When compared with patients who stayed p = .008), multiorgan failure (OR, 8.06 (3.43–19.9); p p p = .002) were independently associated with prolonged ICU stay. In-hospital mortality rate was 9%. Cardiac arrest occurring in the prehospital setting and during the first hours of ICU management (OR, 27.31 (8.99–158.76); p p p = .002) was independently associated with reduced risk of death. Self-poisoned patients with prolonged ICU stay of ≥7days are characterized by concerning high rates of morbidities and poisoning-attributed complications. Acute kidney injury, multiorgan failure, aspiration pneumonia, and delayed awakening are associated with ICU stay prolongation. Cardiac arrest occurrence and delayed awakening are predictive of death. Further studies should focus on the role of early goal-directed therapy and patient-targeted sedation in reducing ICU length of stay among self-poisoned patients.

鉴于在发达国家，自我中毒患者在重症加强护理病房（Intensive Care Unit, ICU）收治后通常可在数日内恢复或死亡，因此重症监护时长延长的相关原因尚未得到充分研究，具有重要研究价值。本研究旨在明确需接受长期重症监护管理的自我中毒患者的临床特征、危险因素、转归及死亡预测因素。

我们开展了一项为期8年的单中心队列研究，纳入所有在ICU停留至少7天的自我中毒患者，排除因药物不良反应及慢性药物过量收治的病例。通过多变量分析，我们将该队列与规模相近的普通自我中毒患者队列进行对比，以探究重症监护时长延长的危险因素。

研究期间，ICU共收治2963例中毒患者，其中停留时长超过7天者占比13.1%（398/2963），包含239例自我中毒患者（女性125例，男性114例；年龄中位数[四分位数间距]为51岁[38~65]；简化急性生理学评分II（Simplified Acute Physiology Score II, SAPS II）为56[43~69]）。涉及的毒物包括精神类药物（59%）、心脏毒性药物（31%）、阿片类药物（15%）及街头毒品（13%）。与停留时长不足7天的患者相比，多器官功能衰竭、吸入性肺炎及觉醒延迟与重症监护时长延长独立相关。院内死亡率为9%。院前及重症监护初始阶段发生的心脏骤停与死亡风险降低独立相关。

需接受≥7天重症监护的自我中毒患者，其并发症及中毒相关并发症发生率较高，值得关注。急性肾损伤、多器官功能衰竭、吸入性肺炎及觉醒延迟与重症监护时长延长相关。心脏骤停发生及觉醒延迟可预测患者死亡风险。未来研究应聚焦于早期目标导向治疗及个体化镇静在缩短自我中毒患者重症监护时长中的作用。