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重症监护病房入院前的临床衰弱量表评分与接受早期康复治疗的脓毒症患者的行动障碍相关。

Clinical Frailty Scale Score Before ICU Admission Is Associated With Mobility Disability in Septic Patients Receiving Early Rehabilitation.

作者信息

Nakajima Hiroki, Nishikimi Mitsuaki, Shimizu Miho, Hayashi Kazuhiro, Inoue Takayuki, Nishida Kazuki, Takahashi Kunihiko, Matsui Shigeyuki, Nishida Yoshihiro, Matsuda Naoyuki

机构信息

Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.

Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Crit Care Explor. 2019 Dec 6;1(12):e0066. doi: 10.1097/CCE.0000000000000066. eCollection 2019 Dec.

Abstract

UNLABELLED

To clarify the relationship between mobility disability at the time of discharge from the ICU and clinical factors evaluated at ICU admission in septic patients.

DESIGN

A single-center, retrospective, observational study.

SETTING

Ten-bed, the emergency and medical ICU.

PATIENTS

We analyzed the data of septic patients who were admitted to our ICU between September 2012 and September 2016 and received early rehabilitation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The patients were categorized into two groups based on their scores on the ICU mobility scale at the time of discharge from the ICU: the mobility disability group (ICU mobility scale score < 9) and the no mobility disability group (ICU mobility scale score ≥ 9). Of the 110 eligible patients, 63 met the inclusion criteria; of these, 46 patients (73%) were classified into the mobility disability group, and 17 patients (27%) were classified into the no mobility disability group. The age (median, 72 vs 64 yr; = 0.024), prevalence of patients with clinical frailty scale scores of greater than or equal to 5 (54% vs 12%; = 0.003), Sequential Organ Failure Assessment score (median, 9.0 vs 6.0; = 0.006) and rate of vasopressin use (26% vs 0%; = 0.026) were significantly higher in the mobility disability group as compared with the no mobility disability group. Among the candidate variables for which values recorded before/at the time of ICU admission were available, the clinical frailty scale score was identified as the only independent, statistically significant predictor of mobility disability at ICU discharge (odds ratio, 7.77; 95% CI, 1.37-44.21; = 0.021). The positive predictive value and negative predictive value of clinical frailty scale scores greater than or equal to 5 for mobility disability at ICU discharge were 92.6% and 41.7%, respectively.

CONCLUSIONS

The clinical frailty scale score was associated with increased mobility disability at ICU discharge in septic patients receiving early rehabilitation.

摘要

未标注

为阐明脓毒症患者重症监护病房(ICU)出院时的活动障碍与ICU入院时评估的临床因素之间的关系。

设计

单中心、回顾性观察研究。

设置

拥有10张床位的急诊与内科ICU。

患者

我们分析了2012年9月至2016年9月期间入住我院ICU并接受早期康复治疗的脓毒症患者的数据。

干预措施

无。

测量指标及主要结果

根据患者在ICU出院时的ICU活动量表评分将患者分为两组:活动障碍组(ICU活动量表评分<9)和无活动障碍组(ICU活动量表评分≥9)。在110例符合条件的患者中,63例符合纳入标准;其中,46例患者(73%)被归入活动障碍组,17例患者(27%)被归入无活动障碍组。活动障碍组患者的年龄(中位数,72岁对64岁;P = 0.024)、临床衰弱量表评分大于或等于5的患者比例(54%对12%;P = 0.003)、序贯器官衰竭评估评分(中位数,9.0对6.0;P = 0.006)以及血管升压素使用比例(26%对0%;P = 0.026)均显著高于无活动障碍组。在可获取ICU入院前/入院时记录值的候选变量中,临床衰弱量表评分被确定为ICU出院时活动障碍的唯一独立且具有统计学意义的预测因素(比值比,7.77;95%置信区间,1.37 - 44.21;P = 0.021)。临床衰弱量表评分大于或等于5对ICU出院时活动障碍的阳性预测值和阴性预测值分别为92.6%和41.7%。

结论

在接受早期康复治疗的脓毒症患者中,临床衰弱量表评分与ICU出院时活动障碍增加相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d928/7063928/985436d3c793/cc9-1-e0066-g001.jpg

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