Miyamoto Kyohei, Shibata Mami, Shima Nozomu, Nakashima Tsuyoshi, Tanaka Rikako, Nakamoto Keita, Imanaka Yuriko, Kato Seiya
Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama 641-0012, Japan.
Department of Nursing, Wakayama Medical University Hospital, Wakayama 641-0012, Japan.
J Clin Med. 2022 Apr 2;11(7):1990. doi: 10.3390/jcm11071990.
Background: We aimed to determine risk factors associated with worsened activity of daily living (ADL) status three months after intensive care unit (ICU) discharge. Methods: In this prospective, observational study, we enrolled critically ill adult patients that were emergently admitted to an ICU. We assessed ADL status by Barthel index score prior to ICU admission and three months after ICU discharge. The primary outcome was worsened ADL status, defined as a ≥10 decrease in Barthel index score. Results: We enrolled 102 patients (median age was 72 years old, 55% were male, and 87% received mechanical ventilation during ICU stay), and 42 patients (41%) had worsened ADL status three months after discharge from ICU. Multivariate analysis revealed that older age (>70 years old; adjusted odds ratio (aOR) 3.68; 95% confidence interval (95%CI) 1.33−10.19), high burden of chronic illness (aOR 4.11; 95%CI 1.43−11.81), and longer duration of mechanical ventilation (≥4 days; aOR 2.83; 95%CI 1.04−7.69) were independent risk factors for worsened ADL status at three months. Conclusions: Almost half of the critically ill adult patients in this cohort had worsened ADL status after ICU discharge. Older age, high burden of chronic illness, and longer duration of mechanical ventilation were risk factors for worsened ADL status.
我们旨在确定与重症监护病房（ICU）出院三个月后日常生活活动（ADL）状态恶化相关的风险因素。方法：在这项前瞻性观察性研究中，我们纳入了紧急入住ICU的成年重症患者。我们在ICU入院前和ICU出院后三个月通过Barthel指数评分评估ADL状态。主要结局是ADL状态恶化，定义为Barthel指数评分下降≥10分。结果：我们纳入了102例患者（中位年龄为72岁，55%为男性，87%在ICU住院期间接受了机械通气），42例患者（41%）在从ICU出院三个月后ADL状态恶化。多变量分析显示，高龄（>70岁；调整后的优势比（aOR）为3.68；95%置信区间（95%CI）为1.33 - 10.19）、慢性病负担重（aOR为4.11；95%CI为1.43 - 11.81）以及机械通气时间长（≥4天；aOR为2.83；95%CI为1.04 - 7.69）是三个月时ADL状态恶化的独立风险因素。结论：该队列中近一半的成年重症患者在ICU出院后ADL状态恶化。高龄、慢性病负担重以及机械通气时间长是ADL状态恶化的风险因素。
