The present study aimed to characterize factors associated with patients issued DNR orders during hospitalization who are discharged alive without any instruction orders by physicians regarding end-of-life treatment, with a focus on the timing of DNR order issuance. In total, 2997 DNR cases from all 61,037 patients aged ≥20 years admitted to a representative general hospital in Tokyo were extracted and divided into two groups by patient hospital release status (discharged alive/deceased). Study items included age, sex, disease type (non-cancer/cancer), hospital department (internal medicine/others), timing of DNR order issuance, implementation (or not) of life-sustaining treatment (LST) or the presence of any restrictions on LST and hospital length of stay. We conducted multiple logistic regression analysis, setting hospital release status as the dependent variable and each above study item as explanatory variables. DNR orders were issued at a rate of 4.9%. The analysis revealed that patients with a DNR who were ultimately discharged alive were statistically more likely to be those for whom DNR orders are issued early after admission (adjusted odds ratio: AOR, 13.7), non-cancer patients (AOR, 3.4), internal medicine department patients (AOR, 1.63), females (AOR, 1.34), and elderly (aged ≥85 years; AOR, 1.02); these patients were also less likely to be receiving LST (AOR, 0.36). By focusing on those with DNR orders who were ultimately discharged alive, we discovered that these patients were likely to have DNR orders issued early after admission, and that they were more likely to be elderly, female, non-cancer patients, or those in internal medicine departments. Further examination of these data may help to elucidate why these particular DNR-related characteristics (including socio-economic and cultural factors) are evident in patients who end up being discharged alive.

中文翻译：

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描述发出 DNR 命令并最终活着出院的患者：日本的一项回顾性观察研究。


本研究旨在描述与住院期间发出 DNR 命令的患者相关的因素，这些患者在没有医生关于临终治疗的任何指令的情况下活着出院，重点是 DNR 命令发出的时间。总共提取了东京一家代表性综合医院收治的所有 61,037 名年龄≥20 岁的患者中的 2997 例 DNR 病例，并根据患者出院状态（活着出院/死亡）分为两组。研究项目包括年龄、性别、疾病类型（非癌症/癌症）、医院科室（内科/其他）、DNR 指令发布时间、实施（或不实施）生命维持治疗 (LST) 或是否存在任何LST 和住院时间的限制。我们以出院情况为因变量，以上述各研究项目为解释变量，进行多元Logistic回归分析。 DNR 订单的签发率为 4.9%。分析显示，最终活着出院的 DNR 患者在统计上更有可能是入院后早期发出 DNR 指令的患者（调整后的比值比：AOR，13.7）、非癌症患者（AOR，3.4）、内部患者内科患者（AOR，1.63）、女性（AOR，1.34）和老年人（年龄≥85岁；AOR，1.02）；这些患者接受 LST 的可能性也较小（AOR，0.36）。通过关注那些最终活着出院的持有 DNR 指令的患者，我们发现这些患者很可能在入院后早期就收到了 DNR 指令，而且他们更有可能是老年、女性、非癌症患者或内科患者。医学部门。 对这些数据的进一步检查可能有助于阐明为什么这些特定的 DNR 相关特征（包括社会经济和文化因素）在最终活着出院的患者中很明显。