Health-related quality of life of patients with multiple organ dysfunction: Individual changes and comparison with normative population
Health-related quality of life of patients with multiple organ dysfunction: Individual changes and comparison with normative population
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DOI：
10.1097/01.ccm.0000059642.97686.8b
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发表时间：
2003-04-01
影响因子：
8.8
通讯作者：
Strauss, R
中科院分区：
文献类型：
--
作者：
Wehler, M;Geise, A;Strauss, R
目的：了解重症监护多脏器功能障碍患者的健康相关生活质量。设计：前瞻性观察性研究。环境：一所大学医院的12个床位的非冠状动脉重症监护室。患者：1998年6月至1999年5月，318例在重症监护病房连续住院的成年患者。测量方法和主要结果：在入院时和6个月随访时，使用一种通用工具——医疗结果研究短表36健康调查——评估与健康相关的生活质量。出现多器官功能障碍的患者（n=170）消耗了重症监护室提供的85%的治疗活动。与年龄和性别调整后的普通人群对照相比，多器官功能障碍患者入院前健康相关生活质量较其他重症监护病房患者差，主要是由于合并症负担较高。在多变量分析中，多器官功能障碍是唯一与随访时身体健康状况恶化独立相关的变量（优势比为4.4；95%可信区间为1.3-14.6;p= 0.015），但对心理健康维度没有影响。分析不同器官系统衰竭的影响，呼吸衰竭（优势比为4.1,95%可信区间为1.6-10.3,p= 0.002）和急性肾功能衰竭（优势比为3.3,95%可信区间为1.0-11.5,p= 0.05）增加了随访时身体健康恶化的风险。没有注意到各种器官系统衰竭对心理健康的影响。在6个月的随访中，83-90%的幸存者恢复了之前与健康相关的生活质量，94%的幸存者与家人住在一起。结论：本研究表明，与匹配的普通人群相比，我们的医疗非冠状动脉患者入院前与健康相关的生活质量显著降低。这表明，在检查重症监护室幸存者的结果时，需要考虑入院前与健康相关的生活质量。多器官功能障碍是随访时身体健康状况不佳的主要决定因素，但对心理健康领域没有影响。
Objective: To determine health-related quality of life in medical intensive care patients with multiple organ dysfunction.Design: Prospective, observational study.Setting: A 12-bed, noncoronary, medical intensive care unit of a university hospital.Patients: Between June 1998 and May 1999, 318 consecutively admitted adult patients with an intensive care unit stay of >24 hrs were studied.Measurements and Main Results: Health-related quality of life was assessed using a generic instrument, the Medical Outcomes Study Short Form-36 Health Survey, at admission and at 6-month follow-up. Patients who developed multiple organ dysfunction (n=170) consumed 85% of the therapeutic activity provided in the intensive care unit. Compared with age- and sex-adjusted general population controls, multiple organ dysfunction patients had a worse preadmission health-related quality of life than other intensive care unit patients, predominantly due to a higher burden of comorbid disease. In a multivariate analysis, multiple organ dysfunction was the only variable independently associated with deteriorated physical health domains at follow-up (odds ratio, 4.4; 95% confidence interval, 1.3-14.6; p=.015), but it had no impact on dimensions of mental health. Analyzing the impact of different organ system failures, respiratory failure (odds ratio, 4.1; 95% confidence interval, 1.6-10.3; p=.002) and acute renal failure (odds ratio, 3.3; 95% confidence interval, 1.0-11.5; p=.05) increased the risk of deteriorated physical health at follow-up. No impact of the various organ system failures on mental health was noted. At 6-month follow-up, 83-90% of survivors had regained their previous health-related quality of life, and 94% were living at home with their families.Conclusions: This study has shown that preadmission health-related quality of life of our medical, noncoronary patients was substantially reduced compared with a matched general population. This demonstrates the need to take prehospitalization health-related quality of life into account when examining the outcomes of intensive care unit survivors. Multiple organ dysfunction was the major determinant of poor physical health at follow-up, but it had no impact on mental health domains.