A retrospective registry-based study into the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their outcomes in Australia and New Zealand

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE Critical Care and Resuscitation Pub Date : 2024-09-01 DOI:10.1016/j.ccrj.2024.06.002

Zheng Jie Lim (Zee) MBBS (Hons), MMed Periop , Dharshi Karalapillai MBBS, PhD, FANZCA, FCICM, PGDipUS , Helen Kolawole BMedSc, MBBS, MClinEd, FANZCA , Chris Fiddes MBBS, FANZCA , David Pilcher MBBS, MRCP, FRACP, FCICM , Ashwin Subramaniam MBBS, MMed, GChPOM, FRACP, FCICM, PhD

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Abstract

Objective

To describe the proportion of patients admitted to intensive care who have anaphylaxis as a principal diagnosis and their subsequent outcomes in Australia and New Zealand.

Design

Retrospective observational study of ICU admissions for severe anaphylaxis.

Setting

ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2012 and 2022.

Participants

Adults 16 years or older with severe anaphylaxis admitted to the ICU.

Interventions

None.

Main outcome measures

Proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis, mortality rate, ICU and hospital length of stay.

Results

7189 of the 7270 ICU admissions for severe anaphylaxis recorded between 2012 and 2022, were included in the analysis. This represented a proportion from 0.25% in 2012 to 0.43% in 2022. ICU and hospital mortality were 0.4% and 0.8%, respectively. The proportion of ICUs reporting at least one severe anaphylaxis each year increased from 61.7% in 2012 to 83.0% in 2022. Most of the patients were discharged home (92.6%, n = 6660). Increasing age (OR = 1.055; 95%CI: 1.008–1.105) and SOFA scores (OR = 1.616; 95%CI: 1.265–2.065), an immunosuppressive chronic condition (OR = 16.572; 95%CI: 3.006–91.349) and an increasing respiratory rate above 16 breaths/min (OR = 1.116; 95%CI: 1.057–1.178) predicted in-hospital mortality in patients with anaphylaxis, while higher GCS decreased in-hospital mortality (OR = 0.827; 95%CI: 0.705–0.969).

Conclusions

The overall proportion of patients admitted to ICU who have anaphylaxis as a principal diagnosis has increased. In-hospital mortality remains low despite the need for vital organ support. Further studies should investigate these identified factors that may predict in-hospital mortality among these patients.

Trial registration

Not applicable.

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基于登记簿的回顾性研究：澳大利亚和新西兰重症监护病房收治的主要诊断为过敏性休克的患者比例及其治疗结果

目的描述澳大利亚和新西兰重症监护病房收治的主要诊断为过敏性休克的患者比例及其随后的预后.设计对重症监护病房收治的严重过敏性休克患者进行回顾性观察研究.设置2012年至2022年期间澳大利亚和新西兰重症监护协会成人患者数据库中记录的重症监护病房收治患者.干预措施无.主要结果测量重症监护病房收治的主要诊断为过敏性休克的患者比例.干预措施无。主要结果测量以过敏性休克为主要诊断的ICU入院患者比例、死亡率、ICU和住院时间。结果在2012年至2022年期间记录的7270例ICU严重过敏性休克入院患者中，有7189例被纳入分析。这一比例从2012年的0.25%上升到2022年的0.43%。重症监护病房和医院的死亡率分别为 0.4% 和 0.8%。每年至少报告一次严重过敏性休克的重症监护室比例从2012年的61.7%增至2022年的83.0%。大多数患者出院回家（92.6%，n = 6660）。年龄增加（OR = 1.055；95%CI：1.008-1.105）、SOFA 评分增加（OR = 1.616；95%CI：1.265-2.065）、免疫抑制性慢性疾病（OR = 16.572；95%CI：3.006-91.349）和呼吸频率超过 16 次/分（OR = 1.116；95%CI：1.057-1.178）预示着住院患者的过敏性休克发生率增加。结论ICU收治的以过敏性休克为主要诊断的患者总比例有所增加。尽管需要重要器官支持，但院内死亡率仍然很低。进一步的研究应调查这些已确定的可能预测这些患者院内死亡率的因素。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.