Rydingsward Jessica E, Horkan Clare M, Mogensen Kris M, Quraishi Sadeq A, Amrein Karin, Christopher Kenneth B
1Department of Rehabilitation, Brigham and Women's Hospital, Boston, MA. 2Department of Medicine, Brigham and Women's Hospital, Boston, MA. 3Department of Nutrition, Brigham and Women's Hospital, Boston, MA. 4Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA. 5Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Austria. 6The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Crit Care Med. 2016 May;44(5):869-79. doi: 10.1097/CCM.0000000000001627.
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.
Single-center retrospective cohort study.
Academic Medical Center.
Ten thousand three hundred forty-three adults who received critical care from 1997 to 2011 and survived hospitalization.
None.
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).
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.
出院时的功能状态可能是危重症幸存者发生不良事件的一个风险因素。我们试图研究危重症幸存者出院时的功能状态与出院后90天全因死亡率风险之间的关联。
单中心回顾性队列研究。
学术医疗中心。
1997年至2011年接受危重症治疗并存活出院的10343名成年人。
无。
感兴趣的暴露因素是由持牌物理治疗师在出院时确定的功能状态，并根据改编自《功能独立性测量》的定性类别进行评分。主要结局是出院后90天全因死亡率。基于每次评估的功能等级逻辑回归模型得出并验证了一个分类风险预测评分。在调整后的逻辑回归模型中，与功能独立的患者相比，出院时功能状态处于最低四分位数的患者出院后90天死亡几率增加（比值比，7.63[95%CI，3.83 - 15.22；p<0.001]）。在出院前至少接受7天物理治疗的患者（n = 2293）中，出院时功能状态有显著改善的患者出院后90天死亡的调整后几率比功能状态无变化的患者低64%（比值比，0.36[95%CI，0.24 - 0.53]；p<0.001）。
危重症幸存者出院时功能状态较低与出院后死亡率增加相关。此外，出院前功能状态改善的患者出院后死亡几率降低。
