A multicenter cross-sectional study on chronic critical illness and surgery-related chronic critical illness in China

Sicheng LI; Jie WU; Xiangyou YU; Suming Luo; Jianzhong Wang; Liang Luo; Xisheng Zheng; Xiaoning Han; Guangyi LI; Yingjie Chen; Chunting Wang; Ling Huang; Qingjun Zeng; Xiuwen WU; Jian′an Ren

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A multicenter cross-sectional study on chronic critical illness and surgery-related chronic critical illness in China

VernacularTitle: 中国慢性危重症及外科相关慢性危重症的多中心横断面研究
Author: Sicheng LI ¹ ; Jie WU ² ; Xiangyou YU ³ ; Suming LUO ⁴ ; Jianzhong WANG ⁵ ; Liang LUO ⁶ ; Xisheng ZHENG ⁷ ; Xiaoning HAN ⁸ ; Guangyi LI ⁹ ; Yingjie CHEN ¹⁰ ; Chunting WANG ¹¹ ; Ling HUANG ¹² ; Qingjun ZENG ¹³ ; Xiuwen WU ¹ ; Jian′an REN ¹
Author Information

1. Research Institute of General Surgery, East War Zone Hospital of PLA, Nanjing 210002, China
2. Department of General Surgery, The Affiliated BenQ Hospital, Nanjing Medical University, Nanjing 210019, China
3. Department of Critical Care Medicine, The First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China
4. Department of Emergency Trauma Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
5. Department of Gastrointestinal Surgery, The First Affiliated Hospital, Gannan Medical College, Jiangxi Ganzhou 341000, China
6. Department of Critical Care Medicine, Wuxi Second People′s Hospital, Jiangsu Wuxi 214002, China
7. Department of General Surgery, Nanyang Central Hospital, Henan Nanyang 473000, China
8. Department of Critical Care Medicine, Affiliated Hospital, Qingdao University, Shandong Qingdao 266555, China
9. Department of General Surgery, Hunan Provincial People′s Hospital, Changsha 410000, China
10. Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Fujian Quanzhou 362200, China
11. Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated of Shandong First Medical University, Jinan 250021, China
12. Department of Critical Care Medicine, Yantai Mountain Hospital, Shandong Yantai 264000, China
13. Department of Gastrointestinal Surgery, The First People′s Hospital of Yueyang City, Hunan Yueyang 414000, China
Publication Type:Journal Article
Keywords: Chronic critical illness; Cross-sectional study; Prevalence; Nutritional support
From: Chinese Journal of Gastrointestinal Surgery 2019;22(11):1027-1033
CountryChina
Language:Chinese
Abstract: Objective:To understand the prevalence, diagnosis and treatment of chronic critical illness (CCI) in China.
Methods:The clinical data of 472 adult patients admitted to ICU in 53 hospitals, including basic information, disease-related data, nutrition program, etc., were collected on May 10, 2019, by means of multi-center cross-sectional study. If surgical intervention was needed or the occurrence of the disease was directly related to the surgery, ICU patients were regarded as surgical ICU cases (n=211). In this study, the diagnostic criteria for CCI were: (1) admission to ICU >14 days;(2) combined with persistent organ dysfunction. The prevalence,distribution and treatment of CCI and surgery-related CCI were recorded and analyzed. The Mann-Whitney U test, chi-square test or Fisher exact test were used for comparative analysis.
Results:Among the 472 ICU patients from 53 hospitals, 326 were male (69.1%) and 146 were female (30.9%). The prevalence of CCI was 30.7% (145/472). Among 211 surgery-related ICU patients, 57 developed CCI with a prevalence of 27.0%. As compared to non-CCI patients, higher APACHE II score [median (IQR) 13.5 (10.0, 18.3) vs. 11.0 (7.0, 16.0), U=2970.000, P=0.007], higher Charlson comorbidity index [median (IQR) 4.0 (2.0, 7.0) vs. 3.0 (1.0, 5.0), U= 3570.000, P=0.036] and higher ratio of breath dysfunction [68.4% (39/57) vs. 48.1% (74/154), χ²=6.939, P=0.008] and renal dysfunction [42.1% (24/57) vs. 18.2% (28/154), χ²=12.821, P<0.001] were found in surgery-related CCI patients. While SOFA score, Glasgow coma score and other visceral function were not significantly different between surgery-related CCI and non-CCI patients (all P>0.05). NUTRIC score showed that surgery-related CCI patients had higher nutritional risk [43.9% (25/57) vs. 26.6%(41/154), U=5.750, P=0.016] and higher ratio of mechanical ventilation [66.7% (38/57) vs. 52.3% (79/154), χ²=3.977, P=0.046] than non-CCI patients. On the survey day, the daily caloric requirements of 50.2% (106/211) of surgery-related ICU patients were calculated according to the standard adult caloric intake index (104.6 to 125.5 kJ·kg^-1·d^-1, 1 kJ=0.239 kcal), and the daily caloric requirements of 46.4% (98/211) of patients were calculated by physicians according to the severity of the patient′s condition. 60.2% (127/211) of nutritional support therapy was enteral nutrition (including a combination of enteral and parenteral nutrition), while the remaining patients received parenteral nutrition (24.6%, 52/211), simple glucose infusion (9.0%, 19/211), or oral diet (6.2%, 13/211). The target calorie of CCI group was 104.6 (87.9, 125.5) kJ·kg^-1·d^-1, and the actual calorie intake accounted for 0.98 (0.80, 1.00) of the target calory. In the non-CCI group, the target calorie was 104.6 (87.9, 125.5) kJ·kg^-1·d^-1, and the actual calorie consumed accounted for 0.91 (0.66, 1.00) of the target calorie. There was no statistically significant difference between two groups (P=0.248, P=0.150).
Conclusion:The prevalence of CCI and surgery-related CCI in ICU is high, along with severe complications, respiratory and renal dysfunction and mechanical ventilation. Surgical patients admitted to ICU are at high nutritional risk, and active and correct nutritional support is essential for such patients.