急性呼吸窘迫综合征幸存者的重症监护质量对生活质量/重返工作的影响：前瞻性观察性患者队列研究（DACAPO）。
Influence of quality of intensive care on quality of life/return to work in survivors of the acute respiratory distress syndrome: prospective observational patient cohort study (DACAPO).
机构信息
Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, 93051, Regensburg, Germany.
出版信息
BMC Public Health. 2020 Jun 5;20(1):861. doi: 10.1186/s12889-020-08943-8.
BACKGROUND
Significant long-term reduction in health-related quality of life (HRQoL) is often observed in survivors of the acute respiratory distress syndrome (ARDS), and return to work (RtW) is limited. There is a paucity of data regarding the relationship between the quality of care (QoC) in the intensive care unit (ICU) and both HRQoL and RtW in ARDS survivors. Therefore, the aim of our study was to investigate associations between indicators of QoC and HRQoL and RtW in a cohort of survivors of ARDS.
METHODS
To determine the influence of QoC on HRQoL and RtW 1 year after ICU-discharge, ARDS patients were recruited into a prospective multi-centre patient cohort study and followed up regularly after discharge. Patients were asked to complete self-report questionnaires on HRQoL (Short Form 12 physical component scale (PCS) and mental component scale (MCS)) and RtW. Indicators of QoC pertaining to volume, structural and process quality, and general characteristics were recorded on ICU level. Associations between QoC indicators and HrQoL and RtW were investigated by multivariable linear and Cox regression modelling, respectively. B values and hazard ratios (HRs) are reported with corresponding 95% confidence intervals (CIs).
RESULTS
877 (of initially 1225 enrolled) people with ARDS formed the DACAPO survivor cohort, 396 were finally followed up to 1 year after discharge. The twelve-month survivors were characterized by a reduced HRQoL with a greater impairment in the physical component (Md 41.2 IQR [34-52]) compared to the mental component (Md 47.3 IQR [33-57]). Overall, 50% of the patients returned to work. The proportion of ventilated ICU patients showed significant negative associations with both 12 months PCS (B = - 11.22, CI -20.71; - 1,74) and RtW (HR = 0,18, CI 0,04;0,80). All other QoC indicators were not significantly related to outcome.
CONCLUSIONS
Associations between ICU QoC and long-term HrQoL and RtW were weak and largely non-significant. Residual confounding by case mix, treatment variables before or during ICU stay and variables pertaining to the post intensive care period (e.g. rehabilitation) cannot be ruled out.
TRIAL REGISTRATION
Clinicaltrials.govNCT02637011. (December 22, 2015, retrospectively registered).
背景
急性呼吸窘迫综合征（ARDS）幸存者的健康相关生活质量（HRQoL）通常会长期显著下降，且重返工作岗位（RtW）受限。关于重症监护病房（ICU）的护理质量（QoC）与 ARDS 幸存者的 HRQoL 和 RtW 之间的关系，数据仍然很少。因此，我们的研究目的是调查 ARDS 幸存者队列中 QoC 指标与 HRQoL 和 RtW 之间的关联。
方法
为了确定 ICU 出院后 QoC 对 HRQoL 和 RtW 的影响，ARDS 患者被纳入前瞻性多中心患者队列研究，并在出院后定期进行随访。患者被要求完成 HRQoL（简短形式 12 项生理成分量表（PCS）和心理成分量表（MCS））和 RtW 的自我报告问卷。在 ICU 层面记录与容量、结构和过程质量以及一般特征相关的 QoC 指标。通过多变量线性和 Cox 回归模型分别研究 QoC 指标与 HRQoL 和 RtW 之间的关联。报告 B 值和危险比（HR）及其相应的 95%置信区间（CI）。
结果
最初纳入的 1225 名 ARDS 患者中有 877 名（DACAPO 幸存者队列），最终有 396 名患者在出院后 1 年时进行了随访。12 个月的幸存者 HRQoL 降低，生理成分（Md 41.2 IQR [34-52]）比心理成分（Md 47.3 IQR [33-57]）受损更大。总体而言，有 50%的患者重返工作岗位。接受机械通气的 ICU 患者比例与 12 个月 PCS（B=-11.22，CI-20.71；-1.74）和 RtW（HR=0.18，CI 0.04；0.80）均呈显著负相关。其他所有 QoC 指标与结果均无显著相关性。
结论
ICU-QoC 与长期 HRQoL 和 RtW 之间的关联较弱，且大部分无统计学意义。无法排除病例组合、ICU 入住前或入住期间的治疗变量以及与 ICU 后阶段（如康复）相关的变量的残余混杂。
试验注册
Clinicaltrials.govNCT02637011（2015 年 12 月 22 日， retrospectively registered）。
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