Davies-Foote Rachel, Trung Truong Ngoc, Duoc Nguyen Van Thanh, Duc Du Hong, Nhat Phung Tran Huy, Trang Vo Thi Nhu, Anh Nguyen Thi Kim, Lieu Pham Thi, Thuy Duong Bich, Phong Nguyen Thanh, Truong Nguyen Thanh, Thanh Pham Ba, Tam Dong Thi Hoai, Thuy Tran Thi Diem, Tuyen Pham Thi, Tan Thanh Tran, Campbell James, Puthucheary Zudin, Yen Lam Minh, Van Hao Nguyen, Thwaites C Louise
London School of Hygiene and Tropical Medicine, London, UK.
Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Trop Med Health. 2021 Jun 21;49(1):50. doi: 10.1186/s41182-021-00336-w.
Tetanus remains common in many low- and middle-income countries, but as critical care services improve, mortality from tetanus is improving. Nevertheless, patients develop severe syndromes associated with autonomic nervous system disturbance (ANSD) and the requirement for mechanical ventilation (MV). Understanding factors associated with worse outcome in such settings is important to direct interventions. In this study, we investigate risk factors for disease severity and long-term physical outcome in adults with tetanus admitted to a Vietnamese intensive care unit.
Clinical and demographic variables were collected prospectively from 180 adults with tetanus. Physical function component scores (PCS), calculated from Short Form Health Survey (SF-36), were assessed in 79 patients at hospital discharge, 3 and 6 months post discharge.
Age, temperature, heart rate, lower peripheral oxygen saturation (SpO) and shorter time from first symptom to admission were associated with MV (OR 1.03 [ 95% confidence interval (CI) 1.00, 1.05], p = 0.04; OR 2.10 [95% CI 1.03, 4.60], p = 0.04; OR 1.04 [ 95% CI 1.01, 1.07], p = 0.02); OR 0.80 [95% CI 0.66, 0.94], p = 0.02 and OR 0.65 [95% CI 0.52, 0.79, p < 0.001, respectively). Heart rate, SpO and time from first symptom to admission were associated with ANSD (OR 1.03 [95% CI 1.01, 1.06], p < 0.01; OR 0.95 [95% CI 0.9, 1.00], p = 0.04 and OR 0.64 [95% CI 0.48, 0.80], p < 0.01, respectively). Median [interquartile range] PCS at hospital discharge, 3 and 6 months were 32.37 [24.95-41.57, 53.0 [41.6-56.3] and 54.8 [51.6-57.3], respectively. Age, female sex, admission systolic blood pressure, admission SpO, MV, ANSD, midazolam requirement, hospital-acquired infection, pressure ulcer and duration of ICU and hospital stay were associated with reduced 0.25 quantile PCS at 6 months after hospital discharge.
MV and ANSD may be suitable endpoints for future research. Risk factors for reduced physical function at 3 months and 6 months post discharge suggest that modifiable features during hospital management are important determinants of long-term outcome.
破伤风在许多低收入和中等收入国家仍然很常见，但随着重症监护服务的改善，破伤风死亡率正在下降。然而，患者会出现与自主神经系统紊乱（ANSD）相关的严重综合征以及机械通气（MV）需求。了解在此类情况下与不良预后相关的因素对于指导干预措施很重要。在本研究中，我们调查了入住越南重症监护病房的成年破伤风患者疾病严重程度和长期身体预后的危险因素。
前瞻性收集了180例成年破伤风患者的临床和人口统计学变量。根据简短健康调查问卷（SF - 36）计算的身体功能成分得分（PCS）在79例患者出院时、出院后3个月和6个月进行评估。
年龄、体温、心率、较低的外周血氧饱和度（SpO）以及从首次症状出现到入院的时间较短与机械通气相关（比值比[OR]1.03[95%置信区间（CI）1.00,1.05]；p = 0.04；OR2.10[95%CI1.03,4.60]；p = 0.04；OR1.04[95%CI1.01,1.07]；p = 0.02；OR0.80[95%CI0.66,0.94]；p = 0.02和OR0.65[95%CI0.52,0.79]；p < 0.001）；心率、SpO以及从首次症状出现到入院时间与自主神经系统紊乱相关（OR1.03[95%CI1.01,1.06]；p < 0.01；OR0.95[95%CI0.9,1.00]；p = 0.04和OR0.64[95%CI0.48,0.80]；p < 0.01）。出院时、3个月和6个月时的PCS中位数[四分位间距]分别为32.37[24.95 - 41.57]、53.0[41.6 - 56.3]和54.8[51.6 - 57.3]；年龄、女性、入院收缩压、入院时SpO、机械通气、自主神经系统紊乱、咪达唑仑需求、医院获得性感染、压疮以及重症监护病房和住院时间与出院后6个月时降低的0.25分位数PCS相关。
机械通气和自主神经系统紊乱可能是未来研究的合适终点。出院后3个月和6个月时身体功能降低的危险因素表明，医院管理期间可改变的特征是长期预后的重要决定因素。
