成人暴发性紫癜患者长期生存的生活质量：一项暴露-未暴露多中心队列研究。

Long-term Quality of Life in Adult Patients Surviving Purpura Fulminans: An Exposed-Unexposed Multicenter Cohort Study.

机构信息

Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil.

Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil.

出版信息

Clin Infect Dis. 2019 Jul 2;69(2):332-340. doi: 10.1093/cid/ciy901.

DOI:10.1093/cid/ciy901

PMID:30335142

Abstract

BACKGROUND

Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated.

METHODS

This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale-Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire.

RESULTS

Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35-83) months and 44 (IQR, 35-72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36-53] vs 54 [IQR, 36-57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24-38] vs 52 [IQR, 42-56]; P = .001) and IADL scores (7 [IQR, 4-8] vs 8 [IQR, 7-8]; P = .021) compared with nonamputated patients.

CONCLUSIONS

Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health.

CLINICAL TRIALS REGISTRATION

NCT03216577.

摘要

背景

尚未评估暴发性紫癜（PF）急性期存活患者的长期健康相关生活质量（HR-QOL）。

方法

这是一项法国多中心暴露-未暴露队列研究，纳入了 2010 年至 2016 年期间在 55 个重症监护病房（ICU）因 PF 入院的患者。PF 急性期存活的成年患者（暴露组）按照年龄、性别和简化急性生理学评分 II 与脓毒症休克存活患者（未暴露组）进行 1:1 匹配。通过电话访谈使用 36 项简短健康调查（SF-36）问卷、医院焦虑和抑郁量表（HAD）、修订后的事件影响量表（IES-R）和日常生活活动（ADL）和工具性日常生活活动（IADL）量表评估 HR-QOL。主要结局测量指标是 SF-36 问卷的生理成分综合评分（PCS）。

结果

37 名 PF 幸存者和 37 名脓毒症休克幸存者分别在 ICU 出院后 55（四分位距 [IQR]，35-83）个月和 44（IQR，35-72）个月进行了电话访谈（P =.23）。暴露组和未暴露组患者的 SF-36 PCS 无显著差异（中位数，47 [IQR，36-53] vs 54 [IQR，36-57]；P =.18）。SF-36 的心理成分综合评分以及 HAD、IES-R、ADL 和 IADL 量表两组之间也无显著差异。在 37 名暴露患者中，需要截肢的患者（n = 12/37 [32%]）的 PCS（34 [IQR，24-38] vs 52 [IQR，42-56]；P =.001）和 IADL 评分（7 [IQR，4-8] vs 8 [IQR，7-8]；P =.021）低于未截肢患者。