Naidech Andrew M, Beaumont Jennifer L, Berman Michael, Francis Brandon, Liotta Eric, Maas Matthew B, Prabhakaran Shyam, Holl Jane, Cella David
1Department of Neurology, Northwestern University, Chicago, IL. 2Departent of Medical Social Sciences, Northwestern University, Chicago, IL. 3Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, IL.
Crit Care Med. 2015 Aug;43(8):1654-9. doi: 10.1097/CCM.0000000000001082.
Worthwhile interventions for intracerebral hemorrhage or subarachnoid hemorrhage generally hinge on whether they improve the odds of good outcome. Although good outcome is correlated with mobility, correlations with other domains of health-related quality of life, such as cognitive function and social functioning, are not well described. We tested the hypothesis that good outcome is more closely associated with mobility than other domains.
We defined "good outcome" as 0 through 3 (independent ambulation or better) versus 4 through 5 (dependent) on the modified Rankin Scale at 1, 3, and 12 months. We simultaneously assessed the modified Rankin Scale and health-related quality of life using web-based computer adaptive testing in the domains of mobility, cognitive function (executive function and general concerns), and satisfaction with social roles and activities. We compared the area under the curve between different health-related quality of life domains.
Neurologic ICU with web-based follow-up.
One hundred fourteen patients with subarachnoid hemorrhage or intracerebral hemorrhage.
None.
We longitudinally followed 114 survivors with data at 1 month, 62 patients at 3 months, and 58 patients at 12 months. At 1 month, area under the curve was highest for mobility (0.957; 95% CI, 0.904-0.98), higher than cognitive function-general concerns (0.819; 95% CI, 0.715-0.888; p = 0.003 compared with mobility), satisfaction with social roles and activities (0.85; 95% CI, 0.753-0.911; p = 0.01 compared with mobility), and cognitive function-executive function (0.879; 95% CI, 0.782-0.935; p = 0.058 compared with mobility). Optimal specificity and sensitivity for receiver operating characteristic analysis were approximately 1.5 SD below the U.S. population mean.
Health-related quality of life assessments reliably distinguished between good and poor outcomes as determined by the modified Rankin Scale. Good outcome indicated health-related quality of life about 1.5 SD below the U.S. population mean. Associations were weaker for cognitive function and social function than mobility.
脑出血或蛛网膜下腔出血的有效干预措施通常取决于它们是否能提高良好预后的几率。虽然良好预后与活动能力相关，但与健康相关生活质量的其他领域，如认知功能和社会功能的相关性描述并不充分。我们检验了这一假设：良好预后与活动能力的关联比与其他领域的关联更为密切。
我们将“良好预后”定义为在1个月、3个月和12个月时改良Rankin量表评分为0至3分（独立行走或更好）与4至5分（依赖）。我们使用基于网络的计算机自适应测试，在活动能力、认知功能（执行功能和一般问题）以及对社会角色和活动的满意度等领域，同时评估改良Rankin量表和健康相关生活质量。我们比较了不同健康相关生活质量领域的曲线下面积。
设有基于网络随访的神经重症监护病房。
114例蛛网膜下腔出血或脑出血患者。
无。
我们对114例幸存者进行了纵向随访，1个月时有数据的患者114例，3个月时有62例，12个月时有58例。在1个月时，活动能力的曲线下面积最高（0.957；95%CI，0.904 - 0.98），高于认知功能 - 一般问题（0.819；95%CI，0.715 - 0.888；与活动能力相比，p = 0.003）、对社会角色和活动的满意度（0.85；95%CI，0.753 - 0.911；与活动能力相比，p = 0.01）以及认知功能 - 执行功能（0.879；95%CI，0.782 - 0.935；与活动能力相比，p = 0.058）。受试者操作特征分析的最佳特异性和敏感性比美国人群均值低约1.5个标准差。
健康相关生活质量评估能够可靠地区分改良Rankin量表所确定的良好和不良预后。良好预后表明健康相关生活质量比美国人群均值低约1.5个标准差。认知功能和社会功能与良好预后的关联比活动能力弱。
