Internações por transtornos psiquiátricos em unidades de terapia intensiva: uma coorte multicêntrica em unidades privadas em Brasília - DF (2016-2024)

Abstract

Background: Intensive care unit (ICU) admissions with a primary psychiatric diagnosis represent a distinct care subgroup and may be associated with acute medical complications. Objective: To describe the clinical-epidemiological profile, temporal trends, and outcomes of ICU admissions with a primary psychiatric diagnosis in three tertiary hospitals within the supplementary health sector in the Federal District, Brazil (2015–2024). Methods: Multicenter retrospective cohort including adults (≥18 years), identified using ICD-10 codes and extracted from the Epimed Monitor® registry. Phase-based temporal analyses used pre-pandemic, pandemic, and post-pandemic periods defined by national regulatory milestones. The primary outcome was prolonged ICU length of stay (LOS ≥7 days); ICU mortality was a descriptive secondary outcome. Results: Among 47,400 ICU admissions, 2,159 (4.55%) had a primary psychiatric diagnosis; 1,348 comprised the final cohort. Most patients were women (71.88%), and self-harm/attempted suicide predominated (63.43%), followed by mood disorders (12.54%) and psychotic disorders (9.72%). LOS ≥7 days occurred in 133 admissions (9.87%). ICU mortality was 0.59% (n=8). In the multivariable model for LOS ≥7 days, higher odds were observed for uncomplicated diabetes (OR 3.26; 95% CI 1.62–6.12), prior stroke without sequelae (OR 7.05; 95% CI 1.16–41.38), focal neurological deficit (OR 6.00; 95% CI 1.94–16.84), pneumonia (OR 16.90; 95% CI 4.75–67.01), and parenteral nutrition (OR 45.07; 95% CI 6.59–886.16). Conclusion: Primary psychiatric ICU admissions were infrequent and had low ICU mortality; prolonged LOS was mainly associated with acute medical complications, and intensive support needs rather than the psychiatric diagnostic category itself.