Research Institute, Hospital do Coração (HCor), São Paulo, Brazil.
Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Intensive Care Med. 2017 Jan;43(1):39-47. doi: 10.1007/s00134-016-4563-5. Epub 2016 Sep 29.
To assess the impact of performance status (PS) impairment 1 week before hospital admission on the outcomes in patients admitted to intensive care units (ICU).
Retrospective cohort study in 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We classified PS impairment according to the Eastern Cooperative Oncology Group (ECOG) scale in absent/minor (PS = 0-1), moderate (PS = 2) or severe (PS = 3-4). We used univariate and multivariate logistic regression analyses to investigate the association between PS impairment and hospital mortality.
PS impairment was moderate in 17.3 % and severe in 6.9 % of patients. The hospital mortality was 14.4 %. Overall, the worse the PS, the higher the ICU and hospital mortality and length of stay. In addition, patients with worse PS were less frequently discharged home. PS impairment was associated with worse outcomes in all SAPS 3, Charlson Comorbidity Index and age quartiles as well as according to the admission type. Adjusting for other relevant clinical characteristics, PS impairment was associated with higher hospital mortality (odds-ratio (OR) = 1.96 (95 % CI 1.63-2.35), for moderate and OR = 4.22 (3.32-5.35), for severe impairment). The effects of PS on the outcome were particularly relevant in the medium range of severity-of-illness. These results were consistent in the subgroup analyses. However, adding PS impairment to the SAPS 3 score improved only slightly its discriminative capability.
PS impairment was associated with worse outcomes independently of other markers of chronic health status, particularly for patients in the medium range of severity of illness.
评估入院前 1 周时的体能状态（PS）损害对入住重症监护病房（ICU）患者结局的影响。
这是一项回顾性队列研究，纳入了 2013 年期间入住 78 个 ICU 的 59693 名患者（内科入院患者占 67%）。我们根据东部肿瘤协作组（ECOG）量表将 PS 损害分为无/轻度（PS=0-1）、中度（PS=2）或重度（PS=3-4）。我们使用单变量和多变量逻辑回归分析来研究 PS 损害与住院死亡率之间的关系。
患者 PS 损害中度占 17.3%，重度占 6.9%。住院死亡率为 14.4%。总体而言，PS 越差，ICU 死亡率和住院死亡率以及住院时间越长。此外，PS 越差的患者出院回家的可能性越低。PS 损害与 SAPS 3、Charlson 合并症指数和年龄四分位数所有范围内以及根据入院类型的所有亚组的较差结局相关。在调整其他相关临床特征后，PS 损害与更高的住院死亡率相关（优势比（OR）=1.96（95%CI 1.63-2.35），中度损害和 OR=4.22（3.32-5.35），重度损害）。PS 对结局的影响在疾病严重程度的中等范围内尤为明显。这些结果在亚组分析中是一致的。然而，将 PS 损害添加到 SAPS 3 评分中仅略微提高了其区分能力。
PS 损害与其他慢性健康状况标志物无关，与较差的结局相关，特别是对于疾病严重程度处于中等范围的患者。
