Hofhuis José G M, Spronk Peter E, van Stel Henk F, Schrijvers Augustinus J P, Rommes Johannes H, Bakker Jan
Department of Intensive Care, Gelre Hospital, Location Lukas, Apeldoorn, The Netherlands.
Anesth Analg. 2008 Dec;107(6):1957-64. doi: 10.1213/ane.0b013e318187bbd8.
Severe sepsis is frequently complicated by organ failure and accompanied by high mortality. Patients surviving severe sepsis can have impaired health-related quality of life (HRQOL). The time course of changes in HRQOL in severe sepsis survivors after discharge from the intensive care unit (ICU) and during a general ward stay have not been studied.
We performed a long-term prospective study in a medical-surgical ICU. Patients with severe sepsis (n = 170) admitted for >48 h were included in the study. We used the Short-form 36 to evaluate the HRQOL of severe sepsis patients before ICU and hospital stay and at 3 and 6 mo after ICU discharge. Furthermore, we compared the results for ICU admission and 6 mo after ICU discharge with those of an age-matched general Dutch population.
At 6 mo after ICU discharge, 95 patients could be evaluated (eight patients were lost to follow-up, 67 died). HRQOL showed a multidimensional decline during the ICU stay and gradual improvement over the 6 mo after ICU discharge for the social functioning, vitality, role-emotional, and mental health dimensions. However, 6 mo after ICU discharge, scores for the physical functioning, role-physical, and general health dimensions were still significantly lower than preadmission values. Physical and Mental Component Scores changed significantly over time. In particular, the Mental Component Score showed a small decline at ICU discharge but recovered rapidly, and at 6 mo after ICU discharge had improved to near normal values. In addition, Short-form 36 scores were lower than those in a matched general population in six of the eight dimensions, with the exception of social functioning and bodily pain. Interestingly, the preadmission HRQOL in surviving patients was already lower in three of the eight dimensions (role-physical, mental health, and vitality) when compared with the general population.
Severe sepsis patients demonstrate a sharp decline of HRQOL during ICU stay and a gradual improvement during the 6 mo after ICU discharge. Recovery begins after ICU discharge to the general ward. Nevertheless, recovery is incomplete in the physical functioning, role-physical, and general health dimensions at 6 mo after ICU discharge compared with preadmission status.
严重脓毒症常并发器官功能衰竭，死亡率高。严重脓毒症幸存者的健康相关生活质量（HRQOL）可能受损。重症监护病房（ICU）出院后及普通病房住院期间，严重脓毒症幸存者HRQOL的变化时间进程尚未得到研究。
我们在一所内科-外科ICU进行了一项长期前瞻性研究。纳入入住ICU超过48小时的严重脓毒症患者（n = 170）。我们使用简短健康调查问卷（Short-form 36）评估严重脓毒症患者在入住ICU和住院前以及ICU出院后3个月和6个月时的HRQOL。此外，我们将ICU入院时和ICU出院后6个月的结果与年龄匹配的荷兰普通人群的结果进行了比较。
在ICU出院后6个月时，95例患者可进行评估（8例失访，67例死亡）。在ICU住院期间，HRQOL呈多维度下降，在ICU出院后的6个月内，社会功能、活力、角色情感和心理健康维度逐渐改善。然而，在ICU出院后6个月，身体功能、角色-身体和总体健康维度的得分仍显著低于入院前值。身体和心理成分得分随时间显著变化。特别是，心理成分得分在ICU出院时略有下降，但迅速恢复，在ICU出院后6个月已改善至接近正常水平。此外，在八个维度中的六个维度上，简短健康调查问卷得分低于匹配的普通人群，社会功能和身体疼痛维度除外。有趣的是，与普通人群相比，存活患者入院前的HRQOL在八个维度中的三个维度（角色-身体、心理健康和活力）上已经较低。
严重脓毒症患者在ICU住院期间HRQOL急剧下降，在ICU出院后的6个月内逐渐改善。从ICU出院到普通病房后开始恢复。然而，与入院前状态相比，在ICU出院后6个月时，身体功能、角色-身体和总体健康维度的恢复并不完全。
