Change in Functional Status During Hospital Admission and Long-Term Health-Related Quality of Life Among Pediatric Septic Shock Survivors.
Change in Functional Status During Hospital Admission and Long-Term Health-Related Quality of Life Among Pediatric Septic Shock Survivors.
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儿科感染性休克幸存者住院期间功能状态的变化以及与健康相关的长期生活质量。
DOI：
10.1097/pcc.0000000000003312
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Keenan,HeatherT
中科院分区：
文献类型：
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作者：
Workman,JenniferK;Reeder,RonW;Banks,RussellK;Zimmerman,JerryJ;Meert,KathleenL;Keenan,HeatherT
目的：调查从住院前基线到出院的功能状态变化是否与脓毒性休克存活儿童的长期健康相关生活质量（HRQL）相关。设计：儿科脓毒症评估后生活（LAPSE）的二次分析，一项社区获得性脓毒性休克儿童的前瞻性队列研究，从2014年1月至2017年6月入组。设置：12个美国学术PICU。患者：儿童，1个月至18岁，存活至出院，并有3个月和/或12个月的HRQL随访数据。干预：无。测量和主要结果：在入组前后和第28天或出院时评估功能状态量表（FSS），以确定基线状态（住院前）。使用两种HRQL测量方法：使用功能状态II-R（FSII-R）测量具有显著发育延迟的儿童;通常，使用儿科生活质量量表（PedsQL）测量发育中的儿童。采用多变量回归模型分别分析各组，以确定从基线到第28天的FSS变化与从PICU入院后3个月和12个月的HRQL之间的相关性。在最初的389名LAPSE参与者中，包括224名（58%）。在发育迟缓儿童（n= 88）中，从PICU入院3个月时，FSS恶化与FSII-R降低相关（-2. 02; 95% CI，-3. 34至-0. 0。71; p= 0.003），但不是12个月。在发育典型儿童（n= 136）中，3个月和12个月时，FSS恶化与PedsQL降低相关。在PICU住院期间出现神经系统损伤的发育典型儿童在12个月时PedsQL下降幅度最大（-14.04个月; 95%CI，-22.15至-5.94个月; p< 0.001）。然而，在控制了神经系统事件后，在3个月和12个月时，恶化的FSS仍然与HRQL-PedsQL差相关（均p< 0.001）。结论：感染性休克住院期间FSS的变化与HRQL的长期降低相关，可以作为识别有此后遗症风险的儿童的有用工具。
OBJECTIVES:To investigate whether change in functional status from pre-hospitalization baseline to hospital discharge is associated with long-term health-related quality of life (HRQL) among children surviving septic shock.DESIGN:Secondary analysis of Life After Pediatric Sepsis Evaluation (LAPSE), a prospective cohort study of children with community-acquired septic shock, enrolled from January 2014 to June 2017.SETTING:Twelve US academic PICUs.PATIENTS:Children, 1 month to 18 years, who survived to hospital discharge and had follow-up data for HRQL at 3 and/or 12 months.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Functional Status Scale (FSS) was assessed around enrollment to ascertain baseline status (pre-hospitalization) and at 28 days or hospital discharge. Two measures of HRQL were utilized: children with significant development delay were measured with the Functional Status II-R (FSII-R); typically, developing children were measured with the Pediatric Quality of Life Inventory (PedsQL). Each group was analyzed separately with multivariable regression modeling to determine the association between change in FSS from baseline to day 28 and HRQL at 3 and 12 months from PICU admission. Of the original 389 LAPSE participants, 224 (58%) are included. Among children with developmental delay (n= 88), worsened FSS was associated with lower FSII-R at 3 months from PICU admission (–2.02; 95% CI,–3.34 to–0.0. 71; p= 0.003), but not 12 months. Among developmentally typical children (n= 136), worsened FSS was associated with lower PedsQL at both 3 and 12 months. Developmentally typical children with a neurologic insult during the PICU stay had the largest decrement in PedsQL at 12 months (–14.04 mo; 95% CI,–22.15 to–5.94 mo; p< 0.001). However, worsened FSS remained associated with poor HRQL-PedsQL at 3 and 12 months, after controlling for neurologic events (both p< 0.001).CONCLUSIONS:Change in FSS during hospitalization for septic shock is associated with long-term reductions in HRQL and could serve as a useful tool for identifying children at risk for this sequela.