Functional Status in ICU Survivors and Out of Hospital Outcomes: A Cohort Study
Functional Status in ICU Survivors and Out of Hospital Outcomes: A Cohort Study
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DOI：
10.1097/ccm.0000000000001627
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发表时间：
2016-05-01
影响因子：
8.8
通讯作者：
Christopher, Kenneth B.
中科院分区：
文献类型：
--
作者：
Rydingsward, Jessica E.;Horkan, Clare M.;Christopher, Kenneth B.
目的：出院时的功能状态可能是危重疾病幸存者不良事件的一个危险因素。我们试图检查重症监护幸存者出院时的功能状态与出院后90天全因死亡风险之间的关系。设计：单中心回顾性队列研究。环境：学术医疗中心。患者：1997年至2011年间接受重症监护并存活的一万三千四十三名成年人。干预措施:没有。测量和主要结果：感兴趣的暴露是由有执照的物理治疗师在出院时确定的功能状态，并根据功能独立性测量的定性分类进行评分。主要结局为出院后90天全因死亡率。根据每个评估的功能等级的逻辑回归模型，得出并验证了分类风险预测评分。在调整后的logistic回归模型中，与独立功能状态患者相比，出院时功能状态最低的四分位数与出院后90天死亡率增加相关（优势比为7.63 [95% CI, 3.83-15.22; p < 0.001]）。在出院前接受过至少7天物理治疗的患者中（n = 2293），出院时功能状态明显改善的患者出院后90天死亡率的调整几率比功能状态无变化的患者低64%（优势比为0.36 [95% CI, 0.24-0.53]; p < 0.001）。结论：危重疾病幸存者出院时较低的功能状态与出院后死亡率增加有关。此外，出院前功能状态改善的患者出院后死亡率降低。
Objectives: Functional status at hospital discharge may be a risk factor for adverse events among survivors of critical illness. We sought to examine the association between functional status at hospital discharge in survivors of critical care and risk of 90-day all-cause mortality after hospital discharge.Design: Single-center retrospective cohort study.Setting: Academic Medical Center.Patients: Ten thousand three hundred forty-three adults who received critical care from 1997 to 2011 and survived hospitalization.Interventions: None.Measurements and Main Results: The exposure of interest was functional status determined at hospital discharge by a licensed physical therapist and rated based on qualitative categories adapted from the Functional Independence Measure. The main outcome was 90-day post hospital discharge all-cause mortality. A categorical risk-prediction score was derived and validated based on a logistic regression model of the function grades for each assessment. In an adjusted logistic regression model, the lowest quartile of functional status at hospital discharge was associated with an increased odds of 90-day postdischarge mortality compared with patients with independent functional status (odds ratio, 7.63 [95% CI, 3.83-15.22; p < 0.001]). In patients who had at least 7 days of physical therapy treatment prior to hospital discharge (n = 2,293), the adjusted odds of 90-day postdischarge mortality in patients with marked improvement in functional status at discharge was 64% less than patients with no change in functional status (odds ratio, 0.36 [95% CI, 0.24-0.53]; p < 0.001).Conclusions: Lower functional status at hospital discharge in survivors of critical illness is associated with increased postdischarge mortality. Furthermore, patients whose functional status improves before discharge have decreased odds of postdischarge mortality.