PloS one · 2026
Persistent critical illness in acute hypoxic respiratory failure: A retrospective cohort study.
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Kalinoski Michael, Bolden Leah, Wang Qi, Dudley R Adams, Mesfin Nathan, Ingraham Nicholas E
Аннотация
INTRODUCTION: Persistent critical illness (PerCI) describes patients with prolonged intensive care unit (ICU) dependence after their acute phase of illness and affects 5-20% of the general ICU population. PerCI has been studied in the general ICU cohort, but prevalence and outcomes remain unclear among mechanically ventilated patients with acute hypoxic respiratory failure (AHRF), a high-risk cohort that is more prone to ICU-associated complications. The objective of this study is to quantify PerCI prevalence, identify risk factors for PerCI development, and describe one-year mortality in this population.
METHODS: We conducted a retrospective study of patients with AHRF (PaO2/FiO2 ratio < 300) requiring mechanical ventilation within 72 hours of ICU admission across a 12-hospital health system (2011-2022). PerCI was defined as ICU length of stay ≥ 10 days. The primary outcome was one-year mortality, modeled using a Cox proportional hazards model with PerCI as a time-varying exposure. To identify risk factors for PerCI while accounting for competing early mortality, we used a dual-model approach: logistic regression comparing PerCI to early death (≤ 10-day mortality) and PerCI to early ICU discharge, with factors associated with both models considered robust predictors.
RESULTS: Among 10,626 eligible patients, 3,107 (29.2%) met criteria for PerCI. One-year survival was 64.2% in the PerCI group compared to 73.8% in the non-PerCI group. After PerCI onset, mortality risk increased threefold (hazard ratio 3.01; 95% CI 2.72-3.33). Factors consistently associated with PerCI across both models included ARDS, pneumonia, aspiration pneumonitis, heart failure, septic shock, weight loss, surgical admission, and postprocedural respiratory and circulatory failure.
CONCLUSION: Nearly one in three mechanically ventilated AHRF patients developed PerCI, far exceeding rates in the general ICU populations and was associated with worse one-year survival. Identifiable clinical risk factors may support earlier goals-of-care conversations and post-ICU care planning in this high-risk population.
METHODS: We conducted a retrospective study of patients with AHRF (PaO2/FiO2 ratio < 300) requiring mechanical ventilation within 72 hours of ICU admission across a 12-hospital health system (2011-2022). PerCI was defined as ICU length of stay ≥ 10 days. The primary outcome was one-year mortality, modeled using a Cox proportional hazards model with PerCI as a time-varying exposure. To identify risk factors for PerCI while accounting for competing early mortality, we used a dual-model approach: logistic regression comparing PerCI to early death (≤ 10-day mortality) and PerCI to early ICU discharge, with factors associated with both models considered robust predictors.
RESULTS: Among 10,626 eligible patients, 3,107 (29.2%) met criteria for PerCI. One-year survival was 64.2% in the PerCI group compared to 73.8% in the non-PerCI group. After PerCI onset, mortality risk increased threefold (hazard ratio 3.01; 95% CI 2.72-3.33). Factors consistently associated with PerCI across both models included ARDS, pneumonia, aspiration pneumonitis, heart failure, septic shock, weight loss, surgical admission, and postprocedural respiratory and circulatory failure.
CONCLUSION: Nearly one in three mechanically ventilated AHRF patients developed PerCI, far exceeding rates in the general ICU populations and was associated with worse one-year survival. Identifiable clinical risk factors may support earlier goals-of-care conversations and post-ICU care planning in this high-risk population.