Penn State College of Medicine, 500 University Dr., Hershey, PA 17033, USA.
Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA.
Medicina (Kaunas). 2023 Sep 7;59(9):1617. doi: 10.3390/medicina59091617.
Chronic critical illness (CCI) is a syndrome characterized by persistent organ dysfunction that requires critical care therapy for ≥14 days. Sepsis and respiratory failure constitute the two primary causes of CCI. A better understanding of this patient population and their clinical course may help to risk-stratify them early during hospitalization. Our objective was to identify whether the source of sepsis (medical versus surgical) affected clinical trajectory and prognosis in patients developing CCI. We describe a cohort of patients having acute respiratory failure and sepsis and requiring critical care therapy in the medical (MICU) or surgical (SICU) critical care units for ≥14 days. Given the relative infrequency of CCI, we use a case series design to examine mortality, functional status, and place of residence (home versus non-home) at one year following their index hospitalization. In medical patients developing CCI ( = 31), the severity of initial organ dysfunction, by SOFA score, was significantly associated with the development of CCI ( = 0.002). Surgical patients with CCI ( = 7) experienced significantly more ventilator-free days within the first 30 days following sepsis onset ( = 0.004), as well as less organ dysfunction at day 14 post-sepsis ( < 0.0001). However, one-year mortality, one-year functional status, and residency at home were not statistically different between cohorts. Moreover, 57% of surgical patients and 26% of medical patients who developed CCI were living at home for one year following their index hospitalization ( = 0.11). While surgical patients who develop sepsis-related CCI experience more favorable 30-day outcomes as compared with medical patients, long-term outcomes do not differ significantly between groups. This suggests that reversing established organ dysfunction and functional disability, regardless of etiology, is more challenging compared to preventing these complications at an earlier stage.
慢性危重症（CCI）是一种以持续器官功能障碍为特征的综合征，需要重症监护治疗≥14 天。脓毒症和呼吸衰竭是 CCI 的两个主要病因。更好地了解这类患者人群及其临床病程，可能有助于在住院期间尽早对其进行风险分层。我们的目的是确定脓毒症的来源（内科还是外科）是否影响发生 CCI 的患者的临床轨迹和预后。
我们描述了一组患有急性呼吸衰竭和脓毒症的患者，他们在内科（MICU）或外科（SICU）重症监护病房接受重症监护治疗≥14 天。鉴于 CCI 的相对罕见性，我们使用病例系列设计来检查他们在索引住院后的一年时的死亡率、功能状态和居住地点（家庭与非家庭）。在发生 CCI 的内科患者中（n=31），初始器官功能障碍的严重程度（SOFA 评分）与 CCI 的发生显著相关（ = 0.002）。发生 CCI 的外科患者（n=7）在脓毒症发作后 30 天内经历了显著更多的无呼吸机天数（ = 0.004），并且在脓毒症后第 14 天的器官功能障碍较少（ < 0.0001）。然而，两组患者的一年死亡率、一年功能状态和家庭居住情况在统计学上没有差异。此外，在发生脓毒症相关 CCI 的外科患者中，有 57%和内科患者中有 26%在索引住院后一年仍居住在家庭中（ = 0.11）。
虽然与内科患者相比，发生脓毒症相关 CCI 的外科患者在 30 天内的结局更有利，但两组之间的长期结局没有显著差异。这表明，与在早期阶段预防这些并发症相比，逆转已确立的器官功能障碍和功能障碍更为困难。
