Evaluation of Patients with Parkinson's Disease in Intensive Care Units: A Cohort Study

Abstract

Background: Parkinson's disease affects approximately 1% of the worldwide population older than 60 years. This number is estimated to double by 2030, increasing the global burden of the disease. Patients with Parkinson's disease are hospitalized 1.5 times more frequently and for longer periods than those without the disease, increasing health-related costs.

Objective: To compare the characteristics and outcome of patients with and without Parkinson's disease admitted to intensive care units (ICUs).

Methods: Historical cohort study of ICU admissions in a Brazilian city over 18 years. All patients with Parkinson's disease identified were matched for age, sex, year, and place of hospitalization with patients without the disease randomly selected from the same database.

Results: The study included 231 patients with Parkinson's disease (PD group) and 462 controls without the disease (NPD group). Compared with patients in the NPD group, those in the PD group were more frequently admitted with lower level of consciousness and increased APACHE II severity score but required less frequently vasoactive drugs. In total, 42.4% of the patients in the PD group were admitted to the ICUs due to sepsis or trauma. Although these patients had longer hospital stay, the mortality rates were comparable between groups. Parkinson's disease was not associated with mortality, even when controlled for associated factors of disease severity.

Conclusion: Although patients with Parkinson's disease were admitted with higher severity scores and remained in the ICU for a longer time, their mortality rate was not higher than that in patients without the disease.

Figure 1

Sample selection flowchart. ^∗Records with the following terms related to Parkinson but not to Parkinson's disease were excluded: “secondary Parkinsonism,” “preexcitation syndrome (Wolff–Parkinson–White syndrome),” “accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, anti-Parkinsonism, and psychotropic drugs, not elsewhere classified,” “intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, anti-Parkinsonism, and psychotropic drugs, not elsewhere classified,” and “poisoning by and exposure to antiepileptic, sedative-hypnotic, anti-Parkinsonism, and psychotropic drugs, not elsewhere classified, undetermined intent.”

Figure 2

Total incidence of hospitalizations between 2000 and 2019 of patients with Parkinson's disease admitted to the intensive care units (ICUs) included in the study, stratified by the age group. A total of 1304 patients younger than 18 years and 371 with no record of age in the database were not included in the analysis.

Figure 3

Comparison of mortality rates between patients with and without Parkinson's disease (PD and NPD groups, respectively) according to the reason for admission to the intensive care unit (ICU). The results are presented in percentages of deaths considering the total number of patients admitted according to the reason for ICU admission stratified by the group. The p values >0.006 refer the significance adjusted of the chi-square test result. n, total number of patients in each group categorized by reason for ICU admission.

Figure 4

Comparison of mortality rates between patients with and without Parkinson's disease (PD and NPD, respectively) according to the source of transfer to the intensive care unit (ICU). The comparison was not performed in the group “another hospital or ICU,” since no patients in the PD group were transferred from another ICU or hospital. The results are presented in percentage of deaths considering the total number of patients admitted according to the source of transfer to the ICU stratified by the PD/NPD group. The p values >0.012 refer the significance adjusted of the chi-square test result.