Employment Outcomes After Critical Illness: An Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors Cohort
Employment Outcomes After Critical Illness: An Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors Cohort
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DOI：
10.1097/ccm.0000000000001849
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发表时间：
2016-11-01
影响因子：
8.8
通讯作者：
Ely, E. Wesley
中科院分区：
文献类型：
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作者：
Norman, Brett C.;Jackson, James C.;Ely, E. Wesley
目的：描述危重病后幸存者的就业状况，并确定住院期间谵妄持续时间和残余认知功能是否与就业减少独立相关。设计：前瞻性队列研究，基线和住院临床数据以及3个月和12个月的随访。设置：两家三级护理医院的内科和外科ICU。患者：在ICU幸存者研究中揭示神经心理功能障碍的危险因素和发生率的既往就业患者中，由于呼吸衰竭或休克而幸存的危重病患者在3个月和12个月随访时评估了总体认知和就业状况。测量和主要结果：我们使用多变量逻辑回归来评估3个月和12个月的就业与同一时间点的整体认知功能之间的独立关联，以及住院期间的谵妄。在3个月随访时，448例总生存队列中的113例（25%）被确定为在研究入组时被雇用。其中94例存活至12个月随访。在3个月和12个月的随访中，62%和49%的人就业减少，其中57%和49%分别是新失业者。在调整了身体健康状况、抑郁症状、婚姻状况、教育水平和疾病严重程度后，我们没有发现3个月时就业状况的显著预测因素，但12个月时更好的认知与12个月时就业减少的可能性较低略有相关结论：重症监护病房幸存者中，大多数人在重症监护病房后就业减少，其中约一半是新的失业。12个月时的认知功能是随后就业状况的预测因子。需要进一步研究危重病对认知功能和就业状况的影响之间的潜在关系。
Objectives: To characterize survivors' employment status after critical illness and to determine if duration of delirium during hospitalization and residual cognitive function are each independently associated with decreased employment.Design: Prospective cohort investigation with baseline and in-hospital clinical data and follow-up at 3 and 12 months.Setting: Medical and surgical ICUs at two tertiary-care hospitals.Patients: Previously employed patients from the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors study who survived a critical illness due to respiratory failure or shock were evaluated for global cognition and employment status at 3- and 12-month follow-up.Measurements and Main Results: We used multivariable logistic regression to evaluate independent associations between employment at both 3 and 12 months and global cognitive function at the same time point, and delirium during the hospital stay. At 3-month follow-up, 113 of the total survival cohort of 448 (25%) were identified as being employed at study enrollment. Of these, 94 survived to 12-month follow-up. At 3- and 12-month follow-up, 62% and 49% had a decrease in employment, 57% and 49% of whom, respectively, were newly unemployed. After adjustment for physical health status, depressive symptoms, marital status, level of education, and severity of illness, we did not find significant predictors of employment status at 3 months, but better cognition at 12 months was marginally associated with lower odds of employment reduction at 12 months (odds ratio, 0.49; p = 0.07).Conclusions: Reduction in employment after critical illness was present in the majority of our ICU survivors, approximately half of which was new unemployment. Cognitive function at 12 months was a predictor of subsequent employment status. Further research is needed into the potential relationship between the impact of critical illness on cognitive function and employment status.