Prognosis of patients aged 80 years and over admitted in medical intensive care unit
Prognosis of patients aged 80 years and over admitted in medical intensive care unit
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DOI：
10.1007/s00134-003-2150-z
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发表时间：
2004-04-01
影响因子：
38.9
通讯作者：
Guidet, B
中科院分区：
文献类型：
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作者：
Boumendil, A;Maury, E;Guidet, B
目标。目的：确定80岁及以上患者进入内科重症监护病房(MICU)后长期生存的预后指标。设计。前瞻性队列研究。设置。法国巴黎，一所拥有970张病床的三级大学医院，设有14张病床的重症监护室。病人。在两年的时间里，共有233名80岁及以上的患者从MICU出院。测量结果和主要结果。入院时的严重程度使用简化的急性生理学评分进行评估。使用MacCabe分类对基础条件进行分类。功能状态采用KNAUS分级进行评定。MICU出院后的结果是在中位数2年的随访后确定的。采用日常生活活动量表(IADL)，通过电话访谈对功能结果进行评估。MICU病死率为19.5%，其中死亡发生在出院后2天。MICU患者2个月、2年和3年的长期存活率分别为59%、33%和29%。多因素分析确定了出院后死亡的两个预后因素：是否存在潜在的致命疾病(HR 1.7；95%CI 1.1-2.6)和严重功能受限(HR 1.7；95%CI 1.2-2.6)。56%的存活患者IADL评定为优或良。结论。MICU后的长期生存主要与基础条件有关，而MICU内生存的已知因素并不影响长期预后。
Objective. To determine the prognostic indicators of long-term survival after admission to a medical intensive care unit (MICU) for patients aged 80 years and over. Design. Prospective cohort study. Setting. A 14-bed MICU in a 970-bed, acute care, tertiary, university hospital in Paris, France. Patients. A total of 233 patients aged 80 years and over discharged from a MICU during a 2-year period. Measurements and main results. Severity at admission was estimated using the Simplified Acute Physiology Score. The underlying condition was classified using the MacCabe classification. The functional status was assessed using the Knaus classification. The outcome after MICU discharge was determined after a median 2-year follow-up. The functional outcome was assessed by telephone interviews, employing the Instrumental Activities of Daily Living (IADL). The in-MICU mortality was 19.5% including death occurring during the 2 days following discharge. The long-term survival rates for patients admitted to the MICU were 59% at 2 months, 33% at 2 years, and 29% at 3 years. The multivariate analysis identified two prognostic factors of death after discharge: presence of an underlying fatal disease (HR 1.7; 95% CI 1.1-2.6) and severe functional limitation (HR 1.7; 95% CI 1.2-2.6). The IADL was excellent or good for 56% of the surviving patients. Conclusion. Long-term survival after MICU is mainly related to the underlying condition, whereas known factors for in-MICU survival do not influence long-term prognosis.