Quality of life before intensive care unit admission is a predictor of survival.
Quality of life before intensive care unit admission is a predictor of survival.
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入住重症监护病房前的生活质量是生存的预测指标。
DOI：
10.1186/cc5970
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发表时间：
2007
期刊：
影响因子：
15.1
通讯作者：
Bakker, Jan
中科院分区：
文献类型：
--
作者：
Hofhuis, Jose Gm;Spronk, Peter E.;Van Stel, Henk F.;Schrijvers, Augustinus Jp;Bakker, Jan
预测重症患者是否能在重症监护治疗中存活下来仍然很困难。采用经过验证的策略来识别那些不会从重症监护病房 (ICU) 治疗中受益的患者的优势是显而易见的。为最终在 ICU 死亡的患者提供重症监护治疗，会给患者及其亲属带来巨大的情感和身体负担。本研究的目的是探讨入住 ICU 之前的健康相关生活质量 (HRQOL) 是否可以用作死亡率的预测指标。我们在一所大学附属教学医院进行了一项前瞻性队列研究。纳入 ICU 入住时间超过 48 小时的患者。近亲在入院后 48 小时内完成简表 36 (SF-36)，以评估患者入院前的 HRQOL。从入住 ICU 到出院 6 个月期间评估死亡率。 Logistic 回归和接受者操作特征分析用于使用五个模型评估死亡率的预测价值：SF-36 关于一般健康的第一个问题（模型 A）； HRQOL使用SF-36（模型B）的身体成分评分（PCS）和心理成分评分（MCS）进行测量；急性生理学和慢性健康评估 (APACHE) II 评分（ICU 患者公认的死亡率预测模型；模型 C）；一般健康状况和 APACHE II 评分（模型 D）；以及 PCS、MCS 和 APACHE II 评分（模型 E）。分类表用于评估敏感性、特异性、阳性和阴性预测值以及似然比。入院 ICU 后 48 小时内共有 451 名患者入院。随访 6 个月时，159 名患者死亡，40 名患者失访。当使用一般健康项目作为HRQOL的估计时，模型A的曲线下面积（0.719）与模型C的曲线下面积（0.721）相当，略优于模型D的曲线下面积（0.760）。当使用PCS和MCS时，模型B的曲线下面积（0.736）与模型C的曲线下面积（0.721）相当，略好于模型E的曲线下面积（0.768）。当使用一般健康项目时，模型D的敏感性和特异性（敏感性0.52和特异性0.81）与模型A（0.45和0.80）相似。使用 MCS 和 PCS 时发现了类似的结果。这项研究表明，通过一项一般健康问题或完整的 SF-36 测量的入院前 HRQOL 与 APACHE II 评分一样，可以很好地预测 ICU 患者的生存/死亡率。尽管将 HRQOL 评估纳入决定患者是否应入住 ICU 时考虑的许多变量中似乎是明智的，但这些措施在临床实践中的价值有限。
Predicting whether a critically ill patient will survive intensive care treatment remains difficult. The advantages of a validated strategy to identify those patients who will not benefit from intensive care unit (ICU) treatment are evident. Providing critical care treatment to patients who will ultimately die in the ICU is accompanied by an enormous emotional and physical burden for both patients and their relatives. The purpose of the present study was to examine whether health-related quality of life (HRQOL) before admission to the ICU can be used as a predictor of mortality. We conducted a prospective cohort study in a university-affiliated teaching hospital. Patients admitted to the ICU for longer than 48 hours were included. Close relatives completed the Short-form 36 (SF-36) within the first 48 hours of admission to assess pre-admission HRQOL of the patient. Mortality was evaluated from ICU admittance until 6 months after ICU discharge. Logistic regression and receiver operating characteristic analyses were used to assess the predictive value for mortality using five models: the first question of the SF-36 on general health (model A); HRQOL measured using the physical component score (PCS) and mental component score (MCS) of the SF-36 (model B); the Acute Physiology and Chronic Health Evaluation (APACHE) II score (an accepted mortality prediction model in ICU patients; model C); general health and APACHE II score (model D); and PCS, MCS and APACHE II score (model E). Classification tables were used to assess the sensitivity, specificity, positive and negative predictive values, and likelihood ratios. A total of 451 patients were included within 48 hours of admission to the ICU. At 6 months of follow up, 159 patients had died and 40 patients were lost to follow up. When the general health item was used as an estimate of HRQOL, area under the curve for model A (0.719) was comparable to that of model C (0.721) and slightly better than that of model D (0.760). When PCS and MCS were used, the area under the curve for model B (0.736) was comparable to that of model C (0.721) and slightly better than that of model E (0.768). When using the general health item, the sensitivity and specificity in model D (sensitivity 0.52 and specificity 0.81) were similar to those in model A (0.45 and 0.80). Similar results were found when using the MCS and PCS. This study shows that the pre-admission HRQOL measured with either the one-item general health question or the complete SF-36 is as good at predicting survival/mortality in ICU patients as the APACHE II score. The value of these measures in clinical practice is limited, although it seems sensible to incorporate assessment of HRQOL into the many variables considered when deciding whether a patient should be admitted to the ICU.
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影响因子：
39.2
作者：
KNAUS, WA;WAGNER, DP;DRAPER, EA
通讯作者：
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影响因子：
120.7
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影响因子：
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影响因子：
8.8
作者：
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通讯作者：
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影响因子：
13.2
作者：
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通讯作者：
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