Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans
Symptoms of Depression in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans
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DOI：
10.1016/j.jagp.2013.01.017
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发表时间：
2013-09-01
影响因子：
7.2
通讯作者：
Iwashyna, Theodore J.
中科院分区：
文献类型：
--
作者：
Davydow, Dimitry S.;Hough, Catherine L.;Iwashyna, Theodore J.
目的：检查严重脓毒症事件是否与随后抑郁症状风险增加相关，并评估哪些患者特征与抑郁症状风险增加相关。设计：前瞻性纵向队列研究。背景：基于人口的美国老年人群体。作为健康与退休研究（1998-2006）的一部分接受采访的成年人。参与者：总共 439 名患者，他们因严重脓毒症住院 471 次，但幸存下来并完成了至少一次随访访谈。测量：使用流行病学研究中心抑郁量表的修改版本来评估抑郁症状。在医疗保险索赔中使用经过验证的算法来识别严重脓毒症。结果：脓毒症发生前中位 1.2 年时，严重抑郁症状的点患病率为 28%，脓毒症发生后中位 0.9 年时，该比例仍为 28%。严重脓毒症事件（相对风险[RR]：1.00；95%置信区间[CI]：0.73，1.34）和严重脓毒症相关的临床特征均与随后的抑郁症状显着相关。这些结果对于来自缺失数据或替代结果定义的潜在威胁是稳健的。调整后，脓毒症前严重抑郁症状（RR：2.20；95％CI：1.66，2.90）和更严重的脓毒症后功能障碍（RR：每个新限制1.08；95％CI：1.03，1.13）与脓毒症后严重抑郁症状独立相关。结论：严重脓毒症幸存者中严重抑郁症状的患病率很高，但相对于脓毒症前的水平并没有增加。识别出这一大群重度抑郁症风险增加的严重脓毒症幸存者，并在出院前开始干预措施，可能会改善结果。
Objectives: To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms. Design: Prospective longitudinal cohort study. Setting: Population-based cohort of older US. adults interviewed as part of the Health and Retirement Study (1998-2006). Participants: A total of 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview. Measurements: Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims. Results: The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.73, 1.34) nor severe sepsis related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, presepsis substantial depressive symptoms (RR: 2.20; 95% CI: 1.66, 2.90) and worse postsepsis functional impairment (RR: 1.08 per new limitation; 95% CI: 1.03, 1.13) were independently associated with substantial depressive symptoms after sepsis. Conclusions: The prevalence of substantial depressive symptoms in severe sepsis survivors is high but is not increased relative to their presepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions before hospital discharge, may improve outcomes.