Prediction of Functional Outcomes from Chronic Critical Illness

摘要 相当数量的危重病人经历持续的器官衰竭导致慢性危重疾病。 (CCI)。这些患者中的大多数在一年内死亡，许多幸存者必须应对长期的身体 以及认知上的限制，通常是严重的。有严重身体和认知功能障碍的生存是一种 在这一人群中有显著的临床、情感和经济负担，但对哪些患者知之甚少 是身体和认知功能障碍的最高风险人群。此外，尽管CCI的长期死亡率可能是 用经过验证的死亡率预测模型可靠地估计，目前还没有经过验证的方法来预测 为共同决策和资源规划目的的长期功能残疾。为了 为了解决这些知识差距，我们将进行第一项多中心前瞻性队列研究，以衡量 CCI患者长期身体和认知功能障碍的危险因素。使用这些风险因素，我们将构建一个 有用和创新的多结果预测模型，以促进共享决策和资源 计划。该项目的具体目标如下： 1.确定CCI患者长期身体和认知功能障碍的危险因素。 2.开发和验证创新的多维临床预测模型，以预测联合 慢性脑梗塞患者的长期生存及身体和认知功能的转归。 我们将通过前瞻性地招募来自5个不同医疗中心的800名患者来实现这些目标 在急性疾病或损伤后需要7天的机械通气，我们将跟踪他们最多1 年。在机械通气的第7天，我们将收集肺功能、神经肌肉无力、急性 脑功能障碍，以及其他选定的临床可用的生物标记物。病前功能性衰退包括 验证的脆弱性指数，以及社会和环境变量将从医疗记录和 家庭面谈。对于第一个目标，这些变量将被评估为严重疾病的独立危险因素 一年后的身体和认知功能障碍，首先关注临床变量，然后关注社交和 经济因素。对于第二个目标，我们将构建和验证单个多结果模型，使用 预测有严重身体残疾的存活率、有严重认知残疾的存活率的单一变量集 有身体和认知障碍的生存，功能正常的生存，以及死亡。这个项目很重要 因为它将直接为患者和临床医生提供了解CCI的新工具，为床边提供信息 针对这一极高风险患者群体的决策以及未来的医疗和资源干预。

ABSTRACT A substantial number of critically ill patients experience persistent organ failure leading to chronic critical illness (CCI). The majority of these patients die within a year, and many survivors must cope with long-term physical and cognitive limitations that are often severe. Survival with severe physical and cognitive dysfunction is a significant clinical, emotional, and economic burden in this population, but little is known about which patients are at highest risk for physical and cognitive dysfunction. Moreover, although long-term mortality in CCI can be reliably estimated with a validated mortality prediction model, there is currently no validated method to predict long-term functional disability for purposes of shared decision making and resource planning. In order to address these gaps in knowledge, we will conduct the first multicenter prospective cohort study that measures risk factors for long-term physical and cognitive dysfunction in CCI. Using these risk factors, we will construct a useful and innovative multi-outcome prognostic model to facilitate shared decision making and resource planning. Specific aims for the project are as follows: 1. Identify risk factors for long-term physical and cognitive dysfunction for patients with CCI. 2. Develop and validate an innovative multi-dimensional clinical prediction model to predict the combined outcome of long-term survival and physical and cognitive function in patients with CCI. We will accomplish these aims by prospectively enrolling 800 patients from 5 diverse medical centers who have required 7 days of mechanical ventilation after acute illness or injury, and we will follow them for up to 1 year. On day 7 of mechanical ventilation we will collect data on lung function, neuromuscular weakness, acute brain dysfunction, and other selected clinically available biomarkers. Premorbid functional decline including validated frailty indices, and social and environmental variables will be obtained from medical records and family interviews. For the first aim these variables will be evaluated as independent risk factors for severe physical and cognitive dysfunction at one-year, focusing first on clinical variables and then on social and economic factors. For the second aim we will construct and validate a single multi-outcome model using a single set of variables to predict survival with severe physical disability, survival with severe cognitive disability, survival with physical and cognitive disability, survival with normal function, and death. This project is important because it will directly provide new tools for patients and clinicians to understand CCI, informing bedside decision making and future medical and resource interventions for this extremely high-risk patient group.