Characteristics, Complications, and Outcomes of Critical Illness in Patients with Parkinson’s Disease.
Ori Lieberman1, Vanja Douglas1, Sara LaHue1
1Neurology, Univ of California, San Francisco
Objective:
Define outcomes of critically ill adults with Parkinson's Disease.
Background:
Adults with Parkinson’s disease (PD) are hospitalized at higher rates than age-matched controls and these hospitalizations are associated with significant morbidity. However, little is known about the consequences of critical illness requiring Intensive Care Unit (ICU)-level care in patients with PD.
Design/Methods:
We performed a retrospective cohort study using the MIMIC-IV dataset, which is comprised of 73,181 ICU admissions at a tertiary care hospital in Boston, MA (2008-2019). We used ICD coding and note text search to identify patients with idiopathic PD. The index ICU admission for these subjects was matched 1:4 with index ICU admissions without a PD diagnosis based on age, sex, comorbidities, SAPSii illness severity score, ICU type and need for mechanical ventilation. Primary outcomes were in-hospital mortality and discharge location. Secondary outcomes were length of stay and prespecified complications. Data were analyzed using logistic or ordinal regression.
Results:
630 subjects with PD were identified. Compared with patients without PD, PD patients were older, more likely to be male, have more comorbidities and higher illness severity at presentation. A matched analysis revealed subjects with PD did not have a significant difference in adjusted in-hospital mortality (OR 1.09; 0.824-1.446) but required a higher level of care on discharge (common OR 1.83; 1.549-2.153). In adjusted analyses, subjects with PD had longer hospital lengths of stay (adjusted mean difference 0.88 days; 0.119-1.641), and increased odds of delirium (OR 1.74; 1.446-2.091), pressure ulcer (OR 1.84; 1.302-2.591) and ileus (OR 1.80; 1.365-2.376), compared with matched controls.
Conclusions:
During critical illness, patients with PD are at increased risk for longer hospital lengths of stay, in-hospital complications, and require higher level of care at discharge than matched controls. These findings reveal targets for interventions to improve outcomes and inform discussions about goals of care in this vulnerable population.