Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
PLoS One. 2019 Apr 4;14(4):e0214602. doi: 10.1371/journal.pone.0214602. eCollection 2019.
Recent studies showed that physical and/or neuropsychiatric impairments significantly affect long-term mortality of ICU survivors. We conducted this study to investigate that simplified measurement of physical function and level of consciousness at hospital discharge by attending nurses could predict long-term outcomes after hospital discharge. A retrospective analysis of prospectively and retrospectively collected data of 246 patients who received medical ICU treatment was conducted. We grouped patients according to physical function and level of consciousness measured by the simplified method at hospital discharge as follow; group A included patients with alert mental and capable of walking or moving by wheel chairs; group B included those with alert mental and bed-ridden status; and Group C included those with confused mental and bed-ridden status. The two-year survival rate after hospital discharge was compared. Of 246 patients, 157 patients were included in the analysis and there were 103 survivors after two-year follow up. Compared to non-survivors, survivors were more likely to be younger (P = 0.026) and have higher body mass index (P = 0.019) and no malignant disease (P = 0.001). There were no statistically significant differences in treatment modalities including medication, use of medical devices, and physical therapy between the survivors and non-survivors. The analysis showed significant differences in survival between the groups classified by physical function (P < 0.001) and level of consciousness (P < 0.01). Multivariate analysis showed that survival rate was significantly lower among the patients in group C than in those in group B or group A (P < 0.001). Simplified method to assess physical function and level of consciousness at hospital discharge can predict long-term outcomes of medical ICU survivors.
最近的研究表明，身体和/或神经精神损伤显著影响 ICU 幸存者的长期死亡率。我们进行这项研究是为了调查出院时由主治护士进行的身体功能和意识水平的简化测量是否可以预测出院后的长期结果。对接受医疗 ICU 治疗的 246 例患者前瞻性和回顾性收集数据进行回顾性分析。我们根据出院时简化方法测量的身体功能和意识水平将患者分组如下：A 组包括神志清醒且能够行走或使用轮椅移动的患者；B 组包括神志清醒且卧床不起的患者；C 组包括神志不清且卧床不起的患者。比较出院后两年的生存率。在 246 例患者中，有 157 例患者纳入分析，有 103 例患者在两年后存活。与非幸存者相比，幸存者更年轻（P = 0.026），体重指数更高（P = 0.019），无恶性疾病（P = 0.001）。幸存者和非幸存者之间的治疗方式，包括药物治疗、使用医疗器械和物理治疗，无统计学差异。根据身体功能（P < 0.001）和意识水平（P < 0.01）进行分组的分析显示，存活组之间存在显著差异。多变量分析显示，C 组患者的生存率明显低于 B 组或 A 组（P < 0.001）。出院时评估身体功能和意识水平的简化方法可以预测医疗 ICU 幸存者的长期预后。
