Spurious Inferences about Long-Term Outcomes The Case of Severe Sepsis and Geriatric Conditions
Spurious Inferences about Long-Term Outcomes The Case of Severe Sepsis and Geriatric Conditions
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DOI：
10.1164/rccm.201109-1660oc
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发表时间：
2012-04-15
影响因子：
24.7
通讯作者：
Cigolle, Christine
中科院分区：
文献类型：
--
作者：
Iwashyna, Theodore J.;Netzer, Giora;Cigolle, Christine
基本原理：危重病的幸存者遭受严重的限制和残疾。目的：确定严重脓毒症是否与所谓的老年疾病的风险增加有关（伤害性福尔斯、低体重指数[BMI]、尿失禁、视力丧失、听力丧失和慢性疼痛）以及这种关联是否在三种不同的研究设计中得到一致的测量。严重脓毒症患者在健康和退休研究中被确定，这是一个具有全国代表性的队列，每两年进行一次采访，1998年至2006年，并在相关的医疗保险索赔中。三个比较器被用来评估严重脓毒症与老年条件的幸存者：在美国人口的患病率在65岁及以上，幸存者自己的前脓毒症水平评估住院前，或幸存者自己的前脓毒症trajectors.Measures和主要结果：六百二十三严重脓毒症住院后，中位数为0.92年。与65岁及以上人群相比，存活的严重脓毒症与低BMI、损伤性福尔斯、尿失禁和视力丧失的发生率增加相关。当比较幸存者与他们自己的脓毒症前水平时，结果相似。低BMI和严重脓毒症的关联持续控制患者的脓毒症前的轨迹时，但有没有严重脓毒症与伤害性福尔斯，尿失禁，视力丧失，听力损失，慢性疼痛后，这样的controls.Conclusions：老年条件是常见的严重脓毒症。然而，严重脓毒症仅与一部分老年疾病的发病率增加相关，而不是所有老年疾病。在研究急性疾病后的结果时，未能测量和控制疾病前的水平和轨迹可能会导致错误的结论。
Rationale: Survivors of critical illness suffer significant limitations and disabilities.Objectives: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.Methods: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory.Measurements and Main Results: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.Conclusions: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.