Berkius Johan, Engerström Lars, Orwelius Lotti, Nordlund Peter, Sjöberg Folke, Fredrikson Mats, Walther Sten M
Crit Care. 2013 Sep 24;17(5):R211. doi: 10.1186/cc13019.
Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.
Fifty-one COPD patients (COPD-ICU group) with an ICU stay longer than 24 hours received a questionnaire at 6, 12 and 24 months after discharge from ICU. HRQL was measured using two generic instruments: the EuroQoL instrument (EQ-5D and EQ-VAS) and the Short Form 36 Health Survey (SF-36). The results were compared to HRQL of two reference groups from the general population; an age- and sex-adjusted reference population (Non-COPD reference) and a reference group with COPD (COPD reference).
HRQL of the COPD-ICU group at 6 months after discharge from ICU was lower compared to the COPD reference group: Median EQ-5D was 0.66 vs. 0.73, P = 0.08 and median EQ-VAS was 50 vs.55, P < 0.05. There were no significant differences in the SF-36 dimensions between the COPD-ICU and COPD-reference groups, although the difference in physical functioning (PF) approached statistical significance (P = 0.059). Patients in the COPD-ICU group who were lost to follow-up after 6 months had low HRQL scores at 6 months. Scores for patients who died were generally lower compared to patients who failed to respond to the questionnaire. The PF and social functioning (SF) scores in those who died were significantly lower compared to patients with a complete follow up. HRQL of patients in the COPD-ICU group that survived a complete 24 months follow up was low but stable with no statistically significant decline from 6 to 24 months after ICU discharge. Their HRQL at 24 months was not significantly different from HRQL in the COPD reference group.
HRQL in COPD survivors after intensive care was low but did not decline from 6 to 24 months after discharge from ICU. Furthermore, HRQL at 24 months was similar to patients with COPD who had not received ICU treatment.
在重症监护病房（ICU）接受治疗的慢性阻塞性肺疾病（COPD）患者死亡率很高。重症监护后的健康相关生活质量（HRQL）是COPD患者、其家属及医疗服务提供者所关注的一个重要问题。然而，针对该患者群体重症监护后的HRQL研究仍然较少。我们的假设是，在ICU接受治疗的COPD患者的HRQL会随时间迅速下降。
51名在ICU住院时间超过24小时的COPD患者（COPD-ICU组）在从ICU出院后的6个月、12个月和24个月时收到一份调查问卷。HRQL使用两种通用工具进行测量：欧洲五维健康量表（EQ-5D和EQ-VAS）以及简明健康调查问卷（SF-36）。将结果与来自普通人群的两个参照组的HRQL进行比较；一个年龄和性别调整后的参照人群（非COPD参照组）以及一个患有COPD的参照组（COPD参照组）。
与COPD参照组相比，COPD-ICU组在从ICU出院后6个月时的HRQL较低：EQ-5D中位数为0.66，而COPD参照组为0.73，P = 0.08；EQ-VAS中位数为50，而COPD参照组为55，P < 0.05。COPD-ICU组和COPD参照组在SF-36维度上没有显著差异，尽管在身体功能（PF）方面的差异接近统计学显著性（P = 0.059）。在6个月后失访的COPD-ICU组患者在6个月时的HRQL得分较低。死亡患者的得分通常低于未对问卷做出回应的患者。与完成随访的患者相比，死亡患者的PF和社会功能（SF）得分显著更低。在ICU出院后存活并完成24个月随访的COPD-ICU组患者的HRQL较低但稳定，从6个月到24个月没有统计学上的显著下降。他们在24个月时的HRQL与COPD参照组没有显著差异。
重症监护后的COPD存活者的HRQL较低，但从ICU出院后6个月到24个月并未下降。此外，24个月时的HRQL与未接受ICU治疗的COPD患者相似。
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