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Outcomes of prolonged mechanic ventilation: a discrimination model based on longitudinal health insurance and death
Hsin-Ming Lu1, Likwang Chen, Jung-Der Wang
1Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Taiwan.
Background:
This study investigated prognosis among patients under prolonged mechanical ventilation (PMV) through exploring the following issues: (1) post-PMV survival rates, (2) factors associated with survival after PMV, and (3) the number of days alive free of hospital stays requiring mechanical ventilation (MV) care after PMV.
Methods:
This is a retrospective cohort study based on secondary analysis of prospectively collected data in the national health insurance system and governmental data on death registry in Taiwan. It used data for a nationally representative sample of 25,482 patients becoming under PMV (> = 21 days) during 1998-2003. We calculated survival rates for the 4 years after PMV, and adopted logistic regression to construct prediction models for 3-month, 6-month, 1-year, and 2-year survival, with data of 1998-2002 for model estimation and the 2003 data for examination of model performance. We estimated the number of days alive free of hospital stays requiring MV care in the immediate 4-year period after PMV, and contrasted patients who had low survival probability with all PMV patients.
Results:
Among these patients, the 3-month survival rate was 51.4%, and the 1-year survival rate was 31.9%. Common health conditions with significant associations with poor survival included neoplasm, acute and unspecific renal failure, chronic renal failure, non-alcoholic liver disease, shock and septicaemia (odd ratio < 0.7, p < 0.05). During a 4-year follow-up period for patients of year 2003, the mean number of days free of hospital stays requiring MV was 66.0 in those with a predicted 6-month survival rate < 10%, and 111.3 in those with a predicted 2-year survival rate < 10%. In contrast, the mean number of days was 256.9 in the whole sample of patients in 2003.
Conclusions:
Neoplasm, acute and unspecific renal failure, shock, chronic renal failure, septicemia, and non-alcoholic liver disease are significantly associated with lower survival among PMV patients. Patients with anticipated death in a near future tend to spend most of the rest of their life staying in hospital using MV services. This calls for further research into assessing PMV care need among patients at different prognosis stages of diseases listed above.
Insights
Prognosis for patients on prolonged mechanical ventilation (PMV) is poor, with significant factors including cancer and kidney failure. Those with poor prognosis spend most of their remaining time in the hospital on mechanical ventilation (MV).
Area of Science:
- Critical Care Medicine
- Pulmonology
- Nephrology
Background:
- Investigating prognosis in patients requiring prolonged mechanical ventilation (PMV) is crucial for understanding outcomes.
- Key areas of focus include post-PMV survival rates, associated prognostic factors, and days alive free from hospital care requiring mechanical ventilation (MV).
Purpose of the Study:
- To determine post-PMV survival rates.
- To identify factors associated with survival after PMV.
- To quantify days alive and free of hospital stays requiring MV care post-PMV.
Main Methods:
- Retrospective cohort study using Taiwanese national health insurance and death registry data.
- Analysis of 25,482 patients on PMV (>= 21 days) from 1998-2003.
- Logistic regression models developed for survival prediction and validated; days free of MV care calculated.
Main Results:
- 3-month survival rate was 51.4%; 1-year survival rate was 31.9%.
- Neoplasm, acute/chronic renal failure, non-alcoholic liver disease, shock, and septicemia were linked to poorer survival (OR < 0.7, p < 0.05).
- Patients with predicted 6-month survival < 10% had 66 days free of MV care; those with predicted 2-year survival < 10% had 111 days, versus 256.9 days for the whole cohort.
Conclusions:
- Specific conditions like neoplasm, renal failure, shock, liver disease, and septicemia significantly reduce survival in PMV patients.
- Patients with poor prognosis often spend the remainder of their lives in hospital requiring MV.
- Further research is needed to assess PMV care needs based on disease prognosis.
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