title: Outcomes of prolonged mechanic ventilation: a discrimination model based on longitudinal health insurance and death certificate data.
abstract: 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.
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Taiwan.
authors.forename: Hsin-Ming
authors.initials: HM
authors.lastname: Lu
authors.forename: Likwang
authors.initials: L
authors.lastname: Chen
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Hung
authors.forename: Ming-Shian
authors.initials: MS
authors.lastname: Lin
authors.forename: Yuan-Horng
authors.initials: YH
authors.lastname: Yan
authors.forename: Cheng-Ren
authors.initials: CR
authors.lastname: Chen
authors.forename: Po-Sheng
authors.initials: PS
authors.lastname: Fan
authors.forename: Lynn Chu
authors.initials: LC
authors.lastname: Huang
authors.forename: Ken N
authors.initials: KN
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D003644:Death Certificates; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008017:Life Expectancy; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D017063:Outcome Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends*; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D015300:Ventilator Weaning / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends