McPeake Joanne, Iwashyna Theodore J, Henderson Philip, Leyland Alastair H, Mackay Daniel, Quasim Tara, Walters Matthew, Harhay Michael, Shaw Martin
Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom.
Lancet Reg Health Eur. 2021 Jul;6:100121. doi: 10.1016/j.lanepe.2021.100121.
: This study aimed to understand the impact of a critical care admission on long-term outcomes, compared to other hospitalised patients without a critical care encounter. A secondary aim was to examine the interrelationship between emotional, physical, and social problems during recovery.
: We utilised data from the UK Biobank, an on-going, prospective population-based cohort study. We employed propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital (first admission to hospital available) without critical care. Structural equation modelling was used to analyse emotional, physical and social outcomes following critical illness and the relationships between these health domains.
: Data from 1,618 patients were analysed. The median time to follow-up in the critical care cohort was 4427 days (IQR:788-6146) vs 4516 days (IQR: 811-6369) in the non-critical care, hospitalised cohort. Across the two time periods assessed (pre and post 2000), patients exposed to critical care were more likely to experience mental health issues such as depression ( < 0.01) and social isolation ( = 0.01) following discharge from hospital. The critical care cohort were also more likely to have social problems such as the requirement for government funded welfare support ( = 0.02). In the critical care cohort, social and emotional health were closely correlated ( < 0.001, 95% CI:0.33-0.54). The nature of physical problems changed over time; pre-2000 there was a significant difference between the critical and non-critical care in physical outcomes following discharge from hospital, however, there was no difference detected between the two cohorts post-2000.
This cohort study has demonstrated that survivors of critical illness have different psycho-social outcomes to matched patients, hospitalised without a critical care encounter.
JM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019-02-16). AHL is part of the Social and Public Health Sciences Unit, funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).
本研究旨在了解重症监护病房收治与未经历重症监护的其他住院患者相比，对长期预后的影响。次要目的是研究康复期间情绪、身体和社会问题之间的相互关系。
我们利用了英国生物银行的数据，这是一项正在进行的基于人群的前瞻性队列研究。我们采用倾向得分匹配法来评估经历重症监护的患者与入住医院（首次入院）但未接受重症监护的患者在预后方面的差异。采用结构方程模型分析危重病后的情绪、身体和社会结局以及这些健康领域之间的关系。
对1618名患者的数据进行了分析。重症监护队列的中位随访时间为4427天（四分位间距：788 - 6146天），而非重症监护的住院队列中位随访时间为4516天（四分位间距：811 - 6369天）。在评估的两个时间段（2000年之前和之后），经历重症监护的患者在出院后更有可能出现心理健康问题，如抑郁（<0.01）和社会隔离（=0.01）。重症监护队列也更有可能出现社会问题，如需要政府资助的福利支持（=0.02）。在重症监护队列中，社会和情绪健康密切相关（<0.001，95%置信区间：0.
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