Comparing Long-Term Prognosis in Chronic Critically Ill Patients: A Case Series Study of Medical versus Surgical Sepsis.
Comparing Long-Term Prognosis in Chronic Critically Ill Patients: A Case Series Study of Medical versus Surgical Sepsis.
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DOI：
10.3390/medicina59091617
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发表时间：
2023-09-07
期刊：
影响因子：
--
通讯作者：
Bonavia AS
中科院分区：
文献类型：
--
作者：
Mancini B;Liu J;Samuelsen A;Howrylak JA;Schultz L;Bonavia AS
背景和目标：慢性危重病（CCI）是一种以持续性器官功能障碍为特征的综合征，需要重症监护治疗≥14天。脓毒症和呼吸衰竭构成CCI的两个主要原因。更好地了解这一患者群体及其临床过程可能有助于在住院期间早期对其进行风险分层。我们的目的是确定脓毒症的来源（内科与外科）是否影响CCI患者的临床轨迹和预后。材料与方法：我们描述了一组患有急性呼吸衰竭和脓毒症并需要在内科（MICU）或外科（SICU）重症监护室接受重症监护治疗≥14天的患者。鉴于CCI的相对罕见，我们使用病例系列设计来检查其指数住院后一年的死亡率、功能状态和居住地（家庭与非家庭）。结果如下：在发生CCI的内科患者（n = 31）中，SOFA评分显示，初始器官功能障碍的严重程度与CCI的发生显著相关（p = 0.002）。CCI手术患者（n = 7）在脓毒症发作后的前30天内经历了显著更多的无呼吸机天数（p = 0.004），以及脓毒症后14天的器官功能障碍较少（p < 0.0001）。然而，一年的死亡率，一年的功能状态，和居住在家里没有统计学差异的队列。此外，57%的外科患者和26%的内科患者在指数住院后在家生活了一年（p = 0.11）。结论：虽然与内科患者相比，发生脓毒症相关CCI的手术患者的30天结局更好，但两组之间的长期结局无显著差异。这表明，与早期预防这些并发症相比，逆转已建立的器官功能障碍和功能障碍（无论病因如何）更具挑战性。
Background and Objectives: Chronic critical illness (CCI) is a syndrome characterized by persistent organ dysfunction that requires critical care therapy for ≥14 days. Sepsis and respiratory failure constitute the two primary causes of CCI. A better understanding of this patient population and their clinical course may help to risk-stratify them early during hospitalization. Our objective was to identify whether the source of sepsis (medical versus surgical) affected clinical trajectory and prognosis in patients developing CCI. Materials and Methods: We describe a cohort of patients having acute respiratory failure and sepsis and requiring critical care therapy in the medical (MICU) or surgical (SICU) critical care units for ≥14 days. Given the relative infrequency of CCI, we use a case series design to examine mortality, functional status, and place of residence (home versus non-home) at one year following their index hospitalization. Results: In medical patients developing CCI (n = 31), the severity of initial organ dysfunction, by SOFA score, was significantly associated with the development of CCI (p = 0.002). Surgical patients with CCI (n = 7) experienced significantly more ventilator-free days within the first 30 days following sepsis onset (p = 0.004), as well as less organ dysfunction at day 14 post-sepsis (p < 0.0001). However, one-year mortality, one-year functional status, and residency at home were not statistically different between cohorts. Moreover, 57% of surgical patients and 26% of medical patients who developed CCI were living at home for one year following their index hospitalization (p = 0.11). Conclusions: While surgical patients who develop sepsis-related CCI experience more favorable 30-day outcomes as compared with medical patients, long-term outcomes do not differ significantly between groups. This suggests that reversing established organ dysfunction and functional disability, regardless of etiology, is more challenging compared to preventing these complications at an earlier stage.
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影响因子：
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影响因子：
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3.4
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3.9
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158.5
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