Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
School of Public Health, University of Minnesota, Minneapolis, MN.
Crit Care Med. 2020 Nov;48(11):1556-1564. doi: 10.1097/CCM.0000000000004524.
Physical and psychologic deficits after an ICU admission are associated with lower quality of life, higher mortality, and resource utilization. This study aimed to examine the prevalence and secular changes of functional status deterioration during hospitalization among nonsurgical critical illness survivors over the past decade.
We performed a retrospective longitudinal cohort analysis.
Analysis performed using the Cerner Acute Physiology and Chronic Health Evaluation outcomes database which included manually abstracted data from 236 U.S. hospitals from 2008 to 2016.
We included nonsurgical adult ICU patients who survived their hospitalization and had a functional status documented at ICU admission and hospital discharge. Physical functional status was categorized as fully independent, partially dependent, or fully dependent.
None.
Functional status deterioration occurred in 38,116 patients (29.3%). During the past decade, functional status deterioration increased in each disease category, as well as overall (prevalence rate ratio, 1.15; 95% CI, 1.13-1.17; p < 0.001). Magnitude of functional status deterioration also increased over time (odds ratio, 1.03; 95% CI, 1.03-1.03; p < 0.001) with hematological, sepsis, neurologic, and pulmonary disease categories having the highest odds of severe functional status deterioration.
Following nonsurgical critical illness, the prevalence of functional status deterioration and magnitude increased in a nationally representative cohort, despite efforts to reduce ICU dysfunction over the past decade. Identifying the prevalence of functional status deterioration and primary etiologies associated with functional status deterioration will elucidate vital areas for further research and targeted interventions. Reducing ICU debilitation for key disease processes may improve ICU survivor mortality, enhance quality of life, and decrease healthcare utilization.
入住 ICU 后出现的身体和心理缺陷与生活质量降低、死亡率升高和资源利用增加有关。本研究旨在调查过去十年间非外科危重病幸存者在住院期间功能状态恶化的流行率和趋势变化。
我们进行了回顾性纵向队列分析。
使用 Cerner Acute Physiology and Chronic Health Evaluation 结局数据库进行分析，该数据库包含 2008 年至 2016 年间来自 236 家美国医院的手动提取数据。
我们纳入了非外科成年 ICU 患者，这些患者在住院期间存活，并且在 ICU 入院和出院时记录了功能状态。身体功能状态分为完全独立、部分依赖或完全依赖。
无。
38116 例患者（29.3%）出现功能状态恶化。在过去十年中，每个疾病类别以及整体的功能状态恶化发生率均增加（流行率比，1.15；95%CI，1.13-1.17；p<0.001）。随着时间的推移，功能状态恶化的程度也在增加（比值比，1.03；95%CI，1.03-1.03；p<0.001），其中血液系统、脓毒症、神经系统和肺部疾病类别的功能状态严重恶化的几率最高。
在非外科危重病患者中，尽管过去十年中努力减少 ICU 功能障碍，但功能状态恶化的流行率和程度在全国代表性队列中增加。确定功能状态恶化的流行率以及与功能状态恶化相关的主要病因将阐明进一步研究和针对性干预的重要领域。减少关键疾病过程的 ICU 衰弱可能会降低 ICU 幸存者的死亡率，提高生活质量并减少医疗保健的使用。
