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入院前较差的生活质量是危重症患者死亡的有力预测指标。

Worse pre-admission quality of life is a strong predictor of mortality in critically ill patients.

作者信息

Özyılmaz Ezgi, Özkan Kuşçu Özlem, Karakoç Emre, Boz Aslı, Orhan Tıraşçı Gülşah, Güzel Rengin, Seydaoğlu Gülşah

机构信息

Department of Chest Disease and Intensive Care Unit, Çukurova University Faculty of Medicine, Adana, Turkey.

Department of Intensive Care Unit, Seyhan State Hospital, Adana, Turkey.

出版信息

Turk J Phys Med Rehabil. 2022 Mar 1;68(1):19-29. doi: 10.5606/tftrd.2022.5287. eCollection 2022 Mar.

Abstract

OBJECTIVES

In this study, we aimed to investigate whether quality of life (QoL) before intensive care unit (ICU) admission could predict ICU mortality in critically ill patients.

PATIENTS AND METHODS

Between January 2019 and April 2019, a total of 105 ICU patients (54 males, 51 females; mean age: 58 years; range, 18 to 91 years) from two ICUs of a tertiary care hospital were included in this cross-sectional, prospective study. Pre-admission QoL was measured by the Short Form (SF)-12- Physical Component Scores (PCS) and Mental Component Scores (MCS) and EuroQoL five-dimension, five-level scale (EQ-5D-5L) within 24 h of ICU admission and mortality rates were estimated.

RESULTS

The overall mortality rate was 28.5%. Pre-admission QoL was worse in the non-survivors independent from age, sex, socioeconomic and education status, and comorbidities. During the hospitalization, the rate of sepsis and ventilator/hospital-acquired pneumonia were similar among the two groups (p>0.05). Logistic regression analysis adjusted for sex, age, education status, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores showed that pre-admission functional status as assessed by the SF-12 MCS (odds ratio [OR]: 14,2; 95% confidence interval [CI]: 2.5-79.0), SF-12 PCS (OR: 10.6; 95% CI: 1.8-62.7), and EQ-5D-5L (OR: 8.0; 95% CI: 1.5-44.5) were found to be independently associated with mortality.

CONCLUSION

Worse pre-admission QoL is a strong predictor of mortality in critically ill patients. The SF-12 and EQ-5D-5L scores are both valuable tools for this assessment. Not only the physical status, but also the mental status before ICU admission should be evaluated in terms of QoL to better utilize ICU resources.

摘要

目的

在本研究中,我们旨在调查重症监护病房(ICU)入院前的生活质量(QoL)是否能够预测危重症患者的ICU死亡率。

患者与方法

在2019年1月至2019年4月期间,来自一家三级医院两个ICU的105例ICU患者(54例男性,51例女性;平均年龄:58岁;范围为18至91岁)被纳入这项横断面前瞻性研究。在ICU入院后24小时内,通过简短健康调查问卷(SF)-12身体成分得分(PCS)和心理成分得分(MCS)以及欧洲五维度五水平量表(EQ-5D-5L)对入院前的生活质量进行测量,并估算死亡率。

结果

总体死亡率为28.5%。在不考虑年龄、性别、社会经济和教育状况以及合并症的情况下,非幸存者入院前的生活质量较差。在住院期间,两组的败血症和呼吸机相关性/医院获得性肺炎发生率相似(p>0.05)。经性别、年龄、教育状况以及急性生理与慢性健康状况评分系统II(APACHE II)评分调整后的逻辑回归分析显示,通过SF-12 MCS评估的入院前功能状态(比值比[OR]:14.2;95%置信区间[CI]:2.5-79.0)、SF-12 PCS(OR:10.6;95% CI:1.8-62.7)以及EQ-5D-5L(OR:8.0;95% CI:1.5-44.5)与死亡率独立相关。

结论

入院前较差的生活质量是危重症患者死亡率的有力预测指标。SF-12和EQ-5D-5L评分都是用于此项评估的有价值工具。为了更好地利用ICU资源,不仅应从生活质量方面评估ICU入院前的身体状况,还应评估心理状况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38e1/9305648/62c62c63d60b/TJPMR-2022-68-1-019-029-F1.jpg

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