Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study.
Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study.
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DOI：
10.1186/cc10121
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
López-Soto A
中科院分区：
文献类型：
--
作者：
Sacanella E;Pérez-Castejón JM;Nicolás JM;Masanés F;Navarro M;Castro P;López-Soto A
老年患者接受 ICU 护理后的长期结果鲜为人知。该研究的目的是评估老年患者从 ICU 出院后 12 个月的功能状态和生活质量。我们前瞻性地研究了 112/230 名健康老年患者（≥65 岁，出院后至少存活 12 个月），在进入 ICU 之前具有完全的功能自主权，无认知障碍。收集入院时采用急性生理学和慢性健康状况评估III（APACHE III）分类诊断的主要诊断、ICU住院时间以及入院和出院时的ICU评分（APACHE II、脓毒症相关器官衰竭评估（SOFA）和OMEGA）。全面的老年评估包括主要老年综合征的存在以及应用劳顿、巴瑟尔和查尔森指数以及认知衰退知情人问卷分别评估功能、合并症和认知状态。 EuroQol-5D 评估了生活质量。数据收集于基线、ICU 和病房住院期间以及出院后 3、6 和 12 个月。配对或非配对 T 检验比较组间差异（连续变量），而卡方检验和 Fisher 精确检验用于比较二分变量。对于单变量分析中显着的变量（P≤0.1），进行正向多元回归分析。只有 48.9% 的患者（平均年龄：73.4 ± 5.5 岁）在出院后 12 个月仍存活，显示与基线状态相比，功能自主性（Lawton 和 Barthel 指数）和生活质量（EuroQol-5D）显着下降（全部 P < 0.001）。多变量分析显示出院时较高的 Barthel 指数和 EQ-5D vas 是功能完全恢复的相关因素（均 P < 0.01）。因此，在出院时 Barthel 指数≥ 60 或 EQ-5D vas ≥ 40 的患者中，完全功能恢复的风险比分别为 4.04（95% CI：1.58 至 10.33；P = 0.005）和 6.1（95% CI：1.9 至 19.9；P < 0.01）。入住 ICU 后老年综合征增加，且在随访期间仍显着增加（P < 0.001）。尽管大多数幸存者的功能状态和生活质量仍与基线相似，但老年患者从 ICU 出院后 12 个月的生存率较低（49%）。然而，老年综合症的患病率增加了两倍。
Long-term outcomes of elderly patients after medical ICU care are little known. The aim of the study was to evaluate functional status and quality of life of elderly patients 12 months after discharge from a medical ICU. We prospectively studied 112/230 healthy elderly patients (≥65 years surviving at least 12 months after ICU discharge) with full functional autonomy without cognitive impairment prior to ICU entry. The main diagnoses at admission using the Acute Physiology and Chronic Health Evaluation III (APACHE III) classification diagnosis and length of ICU stay and ICU scores (APACHE II, Sepsis-related Organ Failure Assessment (SOFA) and OMEGA) at admission and discharge were collected. Comprehensive geriatric assessment included the presence of the main geriatric syndromes and the application of Lawton, Barthel, and Charlson Indexes and Informant Questionnaire on Cognitive Decline to evaluate functionality, comorbidity and cognitive status, respectively. The EuroQol-5D assessed quality of life. Data were collected at baseline, during ICU and ward stay and 3, 6 and 12 months after hospital discharge. Paired or unpaired T-tests compared differences between groups (continuous variables), whereas the chi-square and Fisher exact tests were used for comparing dichotomous variables. For variables significant (P ≤ 0.1) on univariate analysis, a forward multiple regression analysis was performed. Only 48.9% of patients (mean age: 73.4 ± 5.5 years) were alive 12 months after discharge showing a significant decrease in functional autonomy (Lawton and Barthel Indexes) and quality of life (EuroQol-5D) compared to baseline status (P < 0.001, all). Multivariate analysis showed a higher Barthel Index and EQ-5D vas at hospital discharge to be associated factors of full functional recovery (P < 0.01, both). Thus, in patients with a Barthel Index ≥ 60 or EQ-5D vas ≥40 at discharge the hazard ratio for full functional recovery was 4.04 (95% CI: 1.58 to 10.33; P = 0.005) and 6.1 (95% CI: 1.9 to 19.9; P < 0.01), respectively. Geriatric syndromes increased after ICU stay and remained significantly increased during follow-up (P < 0.001). The survival rate of elderly medical patients 12 months after discharge from the ICU is low (49%), although functional status and quality of life remained similar to baseline in most of the survivors. However, there was a two-fold increase in the prevalence of geriatric syndromes.
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影响因子：
3.1
作者：
Pisani, Margaret A
通讯作者：
Pisani, Margaret A
影响因子：
4
作者：
Somme, Dominique;Andrieux, Nathalie;Saint-Jean, Olivier
通讯作者：
Saint-Jean, Olivier
影响因子：
38.9
作者：
Angus, DC;Carlet, J
通讯作者：
Carlet, J
影响因子：
120.7
作者：
CHELLURI, L;PINSKY, MR;GRENVIK, A
通讯作者：
GRENVIK, A
DOI：
10.1186/cc8231
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Tabah A;Philippart F;Timsit JF;Willems V;Français A;Leplège A;Carlet J;Bruel C;Misset B;Garrouste-Orgeas M
通讯作者：
Garrouste-Orgeas M