Long-term cognitive impairment and functional disability among survivors of severe sepsis.
Long-term cognitive impairment and functional disability among survivors of severe sepsis.
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DOI：
10.1001/jama.2010.1553
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发表时间：
2010-10-27
期刊：
影响因子：
--
通讯作者：
Langa KM
中科院分区：
文献类型：
--
作者：
Iwashyna TJ;Ely EW;Smith DM;Langa KM
认知障碍和功能残疾是决定生存需求和社会医疗保健成本的主要因素。虽然严重脓毒症的发病率很高，而且还在上升，特别是在老年人中，但脓毒症后患者长期认知和功能限制的程度尚不清楚。确定严重脓毒症患者认知障碍和身体功能的变化，控制其脓毒症前的功能。前瞻性队列。健康与退休研究（HRS）在1998年至2006年期间每两年对美国老年人的全国代表性队列进行访谈。1998 - 2004年，有9，223名HRS受访者有相关的医疗保险索赔，他们进行了基线认知和功能评估。根据与HRS相关的医疗保险索赔，1，194名患者中发生了1，520例严重脓毒症住院治疗。在该组中，516名患者在623次严重脓毒症发作中存活，并至少进行了1次随访调查，并在此处进行了分析。对照组包括5，574名在研究期间经历非脓毒症一般住院的受访者，其中4，517人存活到至少1次随访调查。使用经验证的改良TICS和IQCODE问卷，与受访者和代理人进行个人访谈，以评估认知障碍。残疾是通过患者需要帮助的ADL和IADL的数量来衡量的。我们使用人内回归来确定脓毒症与残疾轨迹变化的相关性，脓毒症后随访长达8年。存活者住院时的平均年龄为76.9岁。在多变量回归分析中，重度脓毒症存活患者中中度/重度认知功能障碍的患病率增加了10.6个百分点，比值比为3.33（95%CI：1.53，7.25）。同样，在脓毒症前无限制的患者（平均1.57个新限制[95% CI：0.99，2.15]，无影响为0个新限制）和脓毒症前轻度/中度限制的患者（平均1.50个新限制[95% CI：0.87，2.12]）中，脓毒症后观察到新功能限制的发生率较高。相比之下，非脓毒症一般住院治疗与中度/重度认知障碍无变化相关。（OR：1.15，95% CI：0.80，1.67，与脓毒症的差异p = 0.012），功能限制的变化要小得多（在住院前无和轻度/中度限制的患者中，平均值分别为0.48 [95% CI：0.39，0.56]和0.43 [95% CI：0.23，0.63]新限制;与脓毒症相比的差异p <0.001和p = 0.001）。认知和身体功能的下降持续长达8年的随访。老年人群中的严重脓毒症与幸存者中大量和持续的新发认知障碍和功能障碍独立相关。这些新缺陷的程度很大，可能导致患者独立生活能力的关键性下降。确定医院和康复护理的可修改组成部分，以防止这些残疾将是有价值的病人和他们的家人。
Cognitive impairment and functional disability are major determinants of caregiving needs and societal healthcare costs. Although the incidence of severe sepsis is high and rising, especially among older adults, the magnitude of patients’ long-term cognitive and functional limitations after sepsis is unknown. Determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis, controlling for their pre-sepsis functioning. Prospective cohort. The Health and Retirement Study (HRS) conducted interviews with a nationally representative cohort of older Americans every 2 years during 1998–2006. There were 9,223 HRS respondents with linked Medicare claims who had a baseline cognitive and functional assessment 1998–2004. 1,520 hospitalizations for severe sepsis occurred in 1,194 patients, as ascertained from Medicare claims linked to the HRS. Of this group, 516 individuals survived 623 episodes of severe sepsis and had at least 1 follow-up survey, and were analyzed here. A comparison group included 5,574 respondents who experienced a non-sepsis general hospitalization in the study period, of whom 4,517 survived to at least 1 follow-up survey for analysis here. None Personal interviews with respondents and proxies were used to assess cognitive impairment using the validated modified-TICS and IQCODE questionnaires. Disability was measured by the number of ADLs and IADLs for which patients needed assistance. We used within-person regression to identify the association of sepsis with changes in the trajectory of disability with up to 8 years of post-sepsis follow-up. Survivors’ mean age at hospitalization was 76.9 years. The prevalence of moderate/severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio of 3.33, (95% CI: 1.53, 7.25) in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis in those with no limits before sepsis (mean 1.57 new limitations [95% CI: 0.99, 2.15], where no effect would be 0 new limitations) and in those with mild/moderate limitations before sepsis (mean 1.50 new limitations [95% CI: 0.87, 2.12]). In contrast, non-sepsis general hospitalizations were associated with no change in moderate/severe cognitive impairment (OR: 1.15, 95% CI: 0.80, 1.67, differences versus sepsis p=0.012) and much smaller changes in functional limitations (mean 0.48 [95% CI: 0.39, 0.56] and 0.43 [95% CI: 0.23, 0.63] new limitations among those with no and mild/moderate limits before hospitalization, respectively; differences versus sepsis p<0.001 and p=0.001). The declines in cognitive and physical function persisted for up to 8 years of follow-up. Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients' ability to live independently. Identifying modifiable components of hospital and rehabilitation care to prevent these disabilities would be valuable for patients and their families.
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del妄作为重症疾病幸存者长期认知障碍的预测指标。
影响因子：
8.8
作者：
Girard TD;Jackson JC;Pandharipande PP;Pun BT;Thompson JL;Shintani AK;Gordon SM;Canonico AE;Dittus RS;Bernard GR;Ely EW
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影响因子：
120.7
作者：
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影响因子：
8.8
作者：
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通讯作者：
Supinski GS
DOI：
10.1111/j.1532-5415.2008.02023.x
发表时间：
2008-12-01
影响因子：
6.3
作者：
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通讯作者：
Covinsky, Kenneth E.