Hemothorax in a medical intensive care unit: incidence, comorbidity and prognostic factors.
OBJECTIVE
There is a lack of data regarding the occurrence of hemothorax in medical intensive care units (ICUs). The purpose of this study was to investigate the incidence, comorbidity and prognostic factors of hemothorax in medical ICU patients.


METHODS
From January 1997 to December 2004, patients with hemothorax that developed during an ICU stay were studied. Hemothorax was considered procedure-related if it developed within 24 hours after an invasive procedure. Medical records were reviewed and analyzed with respect to patients' demographic data, underlying diseases, reasons for admission, Acute Physiology and Chronic Health Evaluation II score, procedures related to hemothorax, management, duration of ICU stay, and outcomes.


RESULTS
Fifty-three patients (0.79%) suffered hemothorax during their ICU stay. Chronic kidney disease (77.4%) was the most common comorbidity. A total of 40 cases (75.5%) were procedure-related. Thoracentesis and chest tube thoracostomy were the most common procedures. The 28-day mortality rate was 35.8%. Multivariate logistic regression analysis revealed that a prothrombin time/international normalized ratio > or = 1.6 (odds ratio = 10.99, 95% confidence interval = 1.08-112.05) and a hemoglobin decrease > or = 3 g/dL (odds ratio = 5.55, 95% confidence interval = 1.26-24.45) were significantly associated with 28-day mortality.


CONCLUSIONS
Chronic kidney disease was the most common comorbidity associated with hemothorax. Patients with chronic kidney disease might require close observation for hemothorax after invasive procedures, such as thoracentesis and chest tube thoracostomy. Prolonged prothrombin time and decreased hemoglobin level might be of prognostic value for critically ill patients with hemothorax.
Chen
Chung-Yu
CY
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hsu
Chia-Lin
CL
Chang
Chia-Hsuin
CH
Chen
Kuan-Yu
KY
Yu
Chong-Jen
CJ
Yang
Pan-Chyr
PC
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006491:Hemothorax / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome