Table 1. Baseline characteristics
|
Total
(N=124)
|
Non-survivors
(N=92)
|
Survivors
(N=32)
|
P value
|
Age (y)
|
66.5±16.5
|
67.8±15.8
|
62.8±18.1
|
0.138
|
Male sex
|
90 (72.6)
|
67 (72.8)
|
23 (71.9)
|
0.917
|
Preoperative comorbidities
|
|
|
|
|
Central nervous system
|
24 (19.4)
|
19 (20.7)
|
5 (15.6)
|
0.535
|
Stroke
|
16 (12.9)
|
13 (14.1)
|
3 (9.4)
|
0.760
|
Cephalomeningitis
|
5 (4.0)
|
3 (3.3)
|
2 (6.3)
|
0.603
|
Parkinsonism
|
2 (1.6)
|
2 (2.2)
|
0 (0.0)
|
>0.999
|
Intracranial aneurysm
|
1 (0.8)
|
1 (1.1)
|
0 (0.0)
|
>0.999
|
Dementia
|
1 (0.8)
|
1 (1.1)
|
0 (0.0)
|
>0.999
|
Respiratory system
|
37 (29.8)
|
27 (29.4)
|
10 (31.3)
|
0.839
|
Smoking a
|
31 (25.0)
|
22 (23.9)
|
9 (28.1)
|
0.636
|
Tuberculosis
|
5 (4.0)
|
5 (5.4)
|
0 (0.0)
|
0.326
|
Asthma
|
4 (3.2)
|
3 (3.3)
|
1 (3.1)
|
>0.999
|
COPD
|
4 (3.2)
|
2 (2.2)
|
2 (6.3)
|
0.274
|
Pulmonary heart disease
|
1 (0.8)
|
1 (1.1)
|
0 (0.0)
|
>0.999
|
Circulatory system
|
79 (63.7)
|
59 (64.1)
|
20 (62.5)
|
0.869
|
Hypertension
|
66 (53.2)
|
49 (53.3)
|
17 (53.1)
|
0.989
|
Coronary heart disease
|
27 (21.8)
|
22 (23.9)
|
5 (15.6)
|
0.328
|
Arrhythmia
|
14 (11.3)
|
8 (8.7)
|
6 (18.8)
|
0.122
|
Cardiomyopathy
|
1 (0.8)
|
1 (1.1)
|
0 (0.0)
|
>0.999
|
Metabolic and immune system
|
35 (28.2)
|
30 (32.6)
|
5 (15.7)
|
0.066
|
Diabetes
|
24 (19.4)
|
21 (22.8)
|
3 (9.4)
|
0.097
|
Hyperlipemia
|
5 (4.0)
|
5 (5.4)
|
0 (0.0)
|
0.326
|
Thyroid disease
|
2 (1.6)
|
2 (2.2)
|
0 (0.0)
|
>0.999
|
Rheumatoid arthritis
|
2 (1.6)
|
1 (1.1)
|
1 (3.1)
|
0.451
|
Gout
|
1 (0.8)
|
1 (1.1)
|
0 (0.0)
|
>0.999
|
Systemic lupus erythematosus
|
1 (0.8)
|
0 (0.0)
|
1 (3.1)
|
0.258
|
NYHA functional classification
|
0.058
|
I
|
63 (50.8)
|
42 (45.7)
|
21 (65.6)
|
|
II
|
34 (27.4)
|
30 (32.6)
|
4 (12.5)
|
|
III
|
17 (13.7)
|
11 (12.0)
|
6 (18.8)
|
|
IV
|
10 (8.1)
|
9 (9.8)
|
1 (3.1)
|
|
Abnormal liver function b
|
5 (4.0)
|
4 (4.4)
|
1 (3.1)
|
>0.999
|
Abnormal renal function c
|
5 (4.0)
|
4 (4.4)
|
1 (3.1)
|
>0.999
|
Radio-/chemotherapy in 6 months
|
4 (3.2)
|
2 (2.2)
|
2 (6.3)
|
0.274
|
Cancer surgery
|
44 (35.5)
|
40 (43.5)
|
4 (12.5)
|
0.002
|
Location of surgery
|
|
|
|
0.015
|
Intra-thoracic
|
45 (36.3)
|
39 (42.4)
|
6 (18.8)
|
|
Intra-abdominal
|
40 (32.3)
|
30 (32.6)
|
10 (31.3)
|
|
Others d
|
39 (31.5)
|
23 (25.0)
|
16 (50.0)
|
|
Preoperative ASA classification
|
|
|
|
0.270
|
I
|
10 (8.1)
|
9 (9.8)
|
1 (3.1)
|
|
II
|
63 (50.8)
|
43 (46.7)
|
20 (62.5)
|
|
III
|
22 (17.7)
|
16 (17.4)
|
6 (18.8)
|
|
IV
|
29 (23.4)
|
24 (26.1)
|
5 (15.6)
|
|
Urgent surgery
|
37 (29.8)
|
27 (29.3)
|
10 (31.3)
|
0.839
|
ICU admission for new onset POCs
|
31 (25.0)
|
18 (19.6)
|
13 (40.6)
|
0.018
|
Scores on ICU admission
|
|
|
|
|
SOFA score
|
7.4±3.3
|
7.6±3.4
|
6.5±2.5
|
0.051
|
APACHE II score
|
20.0±7.3
|
20.9±7.7
|
19±5.7
|
0.210
|
Results are presented as mean ± SD and numbers (%).
COPD, chronic obstructive pulmonary diseases. NYHA, the New York Heart Association. ICU, intensive care unit. POCs, postoperative complications. SOFA, sequential organ failure assessment. APACHE, acute physiology and chronic health evaluation.
a Smoking for more than 10 cigarettes per day for more than 1 year, including current or past smokers.
b Serum alanine transaminase or aspartate transaminase higher than 5 times of the normal upper limit.
c Defined as glomerular filtration rate (GFR) <60 ml/min/1.73 m2.
d Include neurosurgery, thyroid surgery and orthopedic surgery.
Table 2. Patients’ situation on the 21st day of mechanical ventilation
Situation on 21st day of MV
|
Total
(N=124)
|
Non-survivors
(N=92)
|
Survivors
(N=32)
|
P value
|
No tracheostomy
|
31 (25.0)
|
30 (32.6)
|
1 (3.1)
|
<0.01
|
Consciousness (GCS=15)
|
74 (59.7)
|
54 (43.6)
|
20 (62.5)
|
0.71
|
Drug-resistant bacteria infection
|
63 (50.8)
|
51 (55.4)
|
12 (37.5)
|
0.08
|
MDR
|
50 (40.3)
|
39 (42.4)
|
11 (34.4)
|
0.43
|
EDR
|
13 (10.5)
|
12 (13.0)
|
1 (3.1)
|
0.18
|
Nutritional supplementation
|
Intolerance of enteral nutritiona
|
43 (34.7)
|
38 (41.3)
|
5 (15.6)
|
0.01
|
Platelet ≤150´109/L
|
49 (39.5)
|
42 (45.7)
|
7 (21.9)
|
0.02
|
On vasopressors
|
41 (33.1)
|
33 (35.9)
|
8 (25.0)
|
0.26
|
On renal replacement therapy
|
24 (19.4)
|
22 (23.9)
|
2 (6.3)
|
0.03
|
Results are presented as mean ± SD, median (interquartile range) and numbers (%).
MV, mechanical ventilation. GCS, Glasgow coma scale. MDR, multi-drug-resistant. XDR, Extensively drug-resistant.
a Included total parenteral and combined enteral-parenteral nutrition.
Table 3. Risk factors in association with 1-year survival (univariate Cox Proportional Hazard analyses)
Risk factors
|
N
|
HR (95% CI) a
|
P value
|
Baseline characteristics
|
|
|
|
Age (y)
|
|
|
|
<50
|
20
|
1.000
|
|
50-64
|
25
|
|
0.89
|
≥65
|
79
|
1.48 (0.81-2.69)
|
0.20
|
Male sex
|
90
|
1.05 (0.66-1.66)
|
0.85
|
Stroke
|
16
|
1.09 (0.60-1.95)
|
0.78
|
Smoking b
|
31
|
1.18 (0.73-1.90)
|
0.51
|
Hypertension
|
66
|
1.09 (0.72-1.64)
|
0.69
|
Coronary heart disease
|
27
|
0.87 (0.54-1.40)
|
0.56
|
NYHA functional classification
|
|
|
|
I+II
|
97
|
1.000
|
|
III+IV
|
27
|
1.01 (0.62-1.66)
|
0.97
|
Diabetes
|
24
|
1.13 (0.89-1.44)
|
0.33
|
Cancer diagnosis
|
44
|
1.20 (0.98-1.48)
|
0.08
|
Location of surgery
|
|
|
|
Others c
|
39
|
1.000
|
|
Intra-thoracic/abdominal
|
85
|
1.73 (1.08-2.78)
|
0.02
|
SOFA score on ICU admission
|
124
|
1.09 (1.01-1.16)
|
0.02
|
APACHE II score on ICU admission
|
124
|
1.03 (1.00-1.06)
|
0.037
|
Situation on the 21st day of MV
|
|
|
|
No tracheostomy
|
31
|
2.67 (1.70-4.17)
|
<0.001
|
Consciousness (GCS=15)
|
74
|
0.79 (0.52-1.20)
|
0.27
|
MDR/XDR bacterial infection
|
63
|
1.53 (1.02-2.32)
|
0.042
|
Intolerance of enteral nutrition d
|
43
|
1.90 (1.25-2.90)
|
<0.01
|
Platelet £150´109/L
|
49
|
1.97 (1.30-2.97)
|
<0.01
|
On vasopressors
|
41
|
1.70 (1.11-2.61)
|
0.02
|
On renal replacement therapy
|
24
|
1.59 (0.97-2.61)
|
0.068
|
HR, hazard ratio. CI, confidence interval. NYHA, the New York Heart Association. ICU, intensive care unit. SOFA, sequential organ failure assessment. APACHE, acute physiology and chronic health enquiry. MV, mechanical ventilation. GCS, Glasgow coma scale. MDR, multi-drug-resistant. XDR, Extensively drug-resistant.
a Factors with number of events >10 were included. b Smoking of more than 10 cigarettes per day for more than 1 year, including current or previous smokers. c Included neurosurgery, thyroid surgery, and orthopedic surgery. d Included total parenteral and combined enteral-parenteral nutrition.
Table 4. Pblackictors of 1-year survival (multivariate Cox Proportional Hazard Model)
Pblackictors
|
Univariate analysis
|
Multivariate
Analysis a
|
P value
|
HR (95% CI)
|
P value
|
Cancer diagnosis
|
0.083
|
2.14 (1.37-3.35)
|
<0.01
|
Intra-thoracic/abdominal surgery (vs. others) b
|
0.023
|
—
|
—
|
SOFA score on ICU admission c
|
0.019
|
—
|
—
|
APACHE II score on ICU admission
|
0.037
|
—
|
—
|
|
No tracheostomy on day 21 of MV
|
<0.001
|
2.01 (1.22-3.30)
|
<0.01
|
MDR/XDR bacterial infection on day 21 of MV
|
0.042
|
—
|
—
|
Intolerance of enteral nutrition on day 21 of MV d
|
0.003
|
1.88 (1.19-2.97)
|
0.01
|
Platelet £150´109/L on day 21 of MV
|
0.001
|
1.77 (1.14-2.75)
|
0.01
|
On vasopressors on day 21 of MV
|
0.015
|
1.74 (1.11-2.74)
|
0.02
|
On renal replacement therapy on day 21 of MV
|
0.068
|
1.71 (1.01-2.91)
|
0.047
|
|
|
|
|
|
HR, hazard ratio. CI, confidence interval. ICU, intensive care unit. SOFA, sequential organ failure assessment. APACHE, acute physiology and chronic health evaluation. MV, mechanical ventilation. MDR, multi-drug-resistant. XDR, Extensively drug-resistant.
a Factors with P <0.10 and number of outcomes >10 were included in the multivariate model (Backward). bIncluded neurosurgery, thyroid surgery, and orthopedic surgery. c Not included because of collinearity with APACHE II score. d Included total parenteral and combined enteral-parenteral nutrition.