| Summary: | 碩士 === 國立臺北護理健康大學 === 長期照護研究所 === 99 === Objective: Acute respiratory distress syndrome came with a high mortality rate as well as high comorbidity. Previous research has devoted the hospital survival rate and to identify high-risk factors associated with it. Little attention has been paid to long-term clinical outcomes and post ARDS comorbidity.The purpose of this study was to explore post ARDS hospital discharge which the prognostic factors and survival time .Further understand the distribution of comorbidity of ARDS patients after suffering from ARDS.
Methods: This was a retrospective cohort study using survival analysis on 200 ARDS patients. Those patients who were diagnosed and hospital survived with ARDS after treated in Intensive Care Unit and survived upon discharge from hospital between January, 2004 and December, 2009 were included in this study. Data on the survival status from their discharge to June, 2010 were obtained via data bank of the National Health Insurance under the permission from the Department of Health. We calculated survival time in months, from 2004/1/1 to 2010/6/30 the number of months total of 78 months.
Results: The findings from the Kaplan-Meier analysis of the results of the ARDS survivors indicated that 70 months (5.8 years) survival rate was 36%, 1-month cumulative survival rate 90.9%, 2-month cumulative survival rate 86.0%, 6 months cumulative survival rate 75.2%, 12-month cumulative survival rate 69.8%, and 24-month cumulative survival rate 59.1%. The result from Cox proportion hazard model analysis of prognostic independent factor in four dimensions were presented in the following: The basic characteristics of independent predictors included the age group (per10 years) and the number of disease history; the ICU admission independent predictor included pre-admission CCI and APACHE II; post ICU care independent predictors included Post ARDS tracheotomy; Hospital discharge independent predictors included Malignancy, Renal, and Discharge disposition. Those identified as independent predictors were significantly associated with the prognosis and survival.
The comorbidity after ARDS were presented as follows: In admission the average CCI was 1.74 ± 1.9. Upon discharge the average CCI was 2.5 ± 2.3. During the post ARDS period, among the categorized diseases, kidney related conditions raised 18%, the highest increase for this group of patients. The neurological disease raised by 15% ranking as the second highest. There were 33% of the patients without any disease before being diagnosed with ARDS. There were only 11% of them without any comorbid disease at the post ARDS stage.
Medical resource utilization and hospital costs were related to younger age, more ICU cormobidity and more severity of illness in ICU, Post ARDS tracheostomy, discharge from hospital and non-survival patient. The largest portion of hospital costs for a survivor
of ARDS was the pharmacy costs and the second most important cost was nursing costs.The ICU LOS was 28.44±23.4 and Hospital LOS was 65.7±55.1。
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