Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Crit Care Med. 2020 Sep;48(9):1271-1279. doi: 10.1097/CCM.0000000000004443.
OBJECTIVES: Although patient's health status before ICU admission is the most important predictor for long-term outcomes, it is often not taken into account, potentially overestimating the attributable effects of critical illness. Studies that did assess the pre-ICU health status often included specific patient groups or assessed one specific health domain. Our aim was to explore patient's physical, mental, and cognitive functioning, as well as their quality of life before ICU admission. DESIGN: Baseline data were used from the longitudinal prospective MONITOR-IC cohort study. SETTING: ICUs of four Dutch hospitals. PATIENTS: Adult ICU survivors (n = 2,467) admitted between July 2016 and December 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients, or their proxy, rated their level of frailty (Clinical Frailty Scale), fatigue (Checklist Individual Strength-8), anxiety and depression (Hospital Anxiety and Depression Scale), cognitive functioning (Cognitive Failure Questionnaire-14), and quality of life (Short Form-36) before ICU admission. Unplanned patients rated their pre-ICU health status retrospectively after ICU admission. Before ICU admission, 13% of all patients was frail, 65% suffered from fatigue, 28% and 26% from symptoms of anxiety and depression, respectively, and 6% from cognitive problems. Unplanned patients were significantly more frail and depressed. Patients with a poor pre-ICU health status were more often likely to be female, older, lower educated, divorced or widowed, living in a healthcare facility, and suffering from a chronic condition. CONCLUSIONS: In an era with increasing attention for health problems after ICU admission, the results of this study indicate that a part of the ICU survivors already experience serious impairments in their physical, mental, and cognitive functioning before ICU admission. Substantial differences were seen between patient subgroups. These findings underline the importance of accounting for pre-ICU health status when studying long-term outcomes.
目的:尽管患者在进入 ICU 之前的健康状况是预测长期预后的最重要因素,但通常并未将其纳入考虑范围,这可能会高估危重病的可归因影响。评估 ICU 前健康状况的研究往往包括特定的患者群体或评估特定的健康领域。我们的目的是探讨患者在进入 ICU 之前的身体、心理和认知功能以及生活质量。
设计:本研究使用了 MONITOR-IC 纵向前瞻性队列研究的基线数据。
地点:荷兰四家医院的 ICU。
患者:2016 年 7 月至 2018 年 12 月期间收治的成年 ICU 幸存者(n=2467)。
干预措施:无。
测量和主要结果:患者或其代理人在进入 ICU 前评估其虚弱程度(临床虚弱量表)、疲劳程度(8 项个体力量检查表)、焦虑和抑郁程度(医院焦虑和抑郁量表)、认知功能(认知失败问卷-14)和生活质量(SF-36)。非计划性入组的患者在进入 ICU 后回顾性地评估其 ICU 前健康状况。在进入 ICU 之前,所有患者中有 13%处于虚弱状态,65%患有疲劳,28%和 26%分别出现焦虑和抑郁症状,6%存在认知问题。非计划性入组的患者明显更虚弱和抑郁。ICU 前健康状况较差的患者往往是女性、年龄较大、受教育程度较低、离婚或丧偶、居住在医疗机构中,并且患有慢性疾病。
结论:在 ICU 后健康问题越来越受到关注的时代,本研究结果表明,一部分 ICU 幸存者在进入 ICU 之前已经出现严重的身体、心理和认知功能障碍。患者亚组之间存在显著差异。这些发现强调了在研究长期预后时考虑 ICU 前健康状况的重要性。
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