The Relationship Between Different Admission Times In ICU And The Prognosis Of Patients

BackgroundIn recent years,with the development of intensive care medicine,the mortality rate of critically ill patients admitted to intensive care units has gradually decreased,but it is still high.Some studies have shown that early treatment,especially the first few hours of treatment,is an important factor affecting the prognosis of patients.The relationship between ICU admission and mortality at different times has been the subject of extensive research,but the results are controversial.ObjectiveThis study explored the relationship between different admission times and the prognosis of ICU patients.Participants and methodsThis study collected data from 3900 adult patients admitted to the Department of Critical Care Medicine of the Second Affiliated Hospital of Guangzhou Medical University for the first time between January 2017 and December 2021 for a retrospective cohort study.The included groups were divided into non-working or working time group,weekend or nonweekend group,night shift or non-night shift group,and nurse APN three shift groups according to different admission times,and multivariate logistics regression analysis and multivariate COX regression analysis were carried out in each group to clarify the relationship between different admission times and the prognosis of ICU patients.ResultsA total of 3900 patients were included in this study.The mean age of the study population was 65.2 ± 17.7 years,64% were male,the median APACHEII score was 18,and the in-hospital mortality rate was 27.7%.Univariate logistics regression analysis showed that compared with patients admitted to ICU on weekdays,the inpatient mortality rate of ICU patients admitted on weekends compared with those admitted to ICU on weekdays was increased(OR 1.24,95% CI 1.05～1.47,P<0.05).There was no significant statistically significant association between night shift hours or non-night shift hours,non-working hours or working hours,and nurses’ APN shift admission to the ICU at any time and the inpatient mortality rate of ICU patients(P>0.05).After the APCHEII score was included in the model for gradual adjustment using the multivariate logistics regression model,the effect of weekend admission on in-hospital mortality in ICU patients lost its statistical significance(OR 1.17,95% CI0.96～1.48,P=0.116),while there was no significant statistical association with inpatient mortality in other time groups(P>0.05).In univariate COX regression analysis,the risk of in-hospital death was increased in patients admitted to ICU during non-working hours compared with working hours,weekends versus working days,and night shifts versus non-night shift(non-working hours: HR 1.23,95% CI 1.07～1.41;weekends: HR 1.16,95%CI 1.01～1.34;night shift: HR 1.16,95% CI 1.02～1.3),and the differences between groups were statistically significant(P<0.05).After the APACHEII score was included in the multivariate COX regression model for correction,although the above admission time still increased the risk of in-hospital death in ICU patients to varying degrees,this relationship lost its statistical significance(non-working hours: HR 1.14,95% CI 0.99～1.31,P=0.065;weekends: HR 1.04,95% CI 1.01～1.34,P=0.636;night shift: HR1.11,95% CI 0.99～).1.26,P=0.083).ConclusionThis study was a single-center retrospective cohort study of adult patients admitted to ICU for the first time to explore the relationship between the length of ICU stay and the prognosis of patients,the results showed that the prognosis of ICU patients in this center was not related to the time of admission,but was closely related to the severity of the disease.This study explored the prognosis of patients admitted to ICU at different time.