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タイトル: Intensive care unit versus high-dependency care unit admission on mortality in patients with septic shock: a retrospective cohort study using Japanese claims data
著者: Endo, Koji
Mizuno, Kayoko  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-6084-9845 (unconfirmed)
Seki, Tomotsugu
Joo, Woo Jin
Takeda, Chikashi
Takeuchi, Masato  KAKEN_id  orcid https://orcid.org/0000-0002-2990-2687 (unconfirmed)
Kawakami, Koji  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-7477-4071 (unconfirmed)
著者名の別形: 遠藤, 功二
水野, 佳世子
関, 知嗣
朱, 祐珍
武田, 親宗
竹内, 正人
川上, 浩司
キーワード: ICU
High-dependency care unit
Hospitalization
Mortality
Length of stay
Septic shock
Admission
Japan
発行日: 2022
出版者: Springer Nature
BMC
誌名: Journal of Intensive Care
巻: 10
論文番号: 35
抄録: [Background] Septic shock is a common and life-threatening condition that requires intensive care. Intensive care units (ICUs) in Japan are classified into ICUs and high-dependency care units (HDUs), depending on presence of full-time certified intensivists and the number of assigned nurses. Compared with other developed countries, there are fewer intensive care beds and certified intensivists in Japan; therefore, non-intensivists often treat patients with septic shock in HDUs. It is unknown where we should treat patients with septic shock because no studies have compared the clinical outcomes between ICU and HDU treatment. This study aimed to elucidate which units should admit patients with septic shock by comparing mortality data and resource use between ICU and HDU admissions. [Methods] In this retrospective cohort study, we used a nationwide Japanese administrative database to identify adult patients with septic shock who were admitted to ICUs or HDUs between January 2010 and February 2021. The patients were divided into two groups, based on admittance to ICU or HDU on the day of hospitalization. The primary outcome was 30-day all-cause mortality adjusted for covariates using Cox regression analyses; the secondary outcomes were the length of ICU or HDU stay and length of hospital stay. [Results] Of the 10, 818 eligible hospitalizations for septic shock, 6584 were in the ICU group, and 4234 were in the HDU group. Cox regression analyses revealed that patients admitted to the ICUs had lower 30-day mortality (adjusted hazard ratio: 0.89; 95% confidence interval: 0.83–0.96; P = 0.005). Linear regression analyses showed no significant difference in hospital length of stay or ICU or HDU length of stay. [Conclusions] An association was observed between ICU admission and lower 30-day mortality in patients with septic shock. These findings could provide essential insights for building a more appropriate treatment system.
著作権等: © The Author(s) 2022
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
URI: http://hdl.handle.net/2433/279190
DOI(出版社版): 10.1186/s40560-022-00627-2
PubMed ID: 35869538
出現コレクション:学術雑誌掲載論文等

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