Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany.
Institute of General Practice and Family Medicine, Jena University Hospital, D-07743, Jena, Germany.
Crit Care. 2024 Jan 29;28(1):35. doi: 10.1186/s13054-024-04815-4.
Post-traumatic stress has been identified as a frequent long-term complication in survivors of critical illnesses after sepsis. Little is known about long-term trajectories of post-traumatic stress and potentially modifiable risk factors following the ICU stay. Study objective was to explore and compare different clinical trajectories of post-traumatic stress symptoms in sepsis survivors up to two years after discharge from ICU.
Data on post-traumatic stress symptoms by means of the Post-traumatic Symptom Scale (PTSS-10) were collected in sepsis survivors at one, six, 12 and 24 months after discharge from ICU. Data on chronic psychiatric diagnoses prior ICU were derived from the primary care provider's health records, and data on intensive care treatment from ICU documentation. Trajectories of post-traumatic symptoms were identified ex post, discriminating patterns of change and k-means clustering. Assignment to the trajectories was predicted in multinomial log-linear models.
At 24 months, all follow-up measurements of the PTSS-10 were completed in N = 175 patients. Three clusters could be identified regarding clinical trajectories of PTSS levels: stable low symptoms (N = 104 patients [59%]), increasing symptoms (N = 45 patients [26%]), and recovering from symptoms (N = 26 patients [15%]). Patients with initially high post-traumatic symptoms were more likely to show a decrease (OR with 95% CI: 1.1 [1.05, 1.16]). Females (OR = 2.45 [1.11, 5.41]) and patients reporting early traumatic memories of the ICU (OR = 4.04 [1.63, 10]) were at higher risk for increasing PTSS levels.
Post-traumatic stress is a relevant long-term burden for sepsis patients after ICU stay. Identification of three different trajectories within two years after ICU discharge highlights the importance of long-term observation, as a quarter of patients reports few symptoms at discharge yet an increase in symptoms in the two years following. Regular screening of ICU survivors on post-traumatic stress should be considered even in patients with few symptoms and in particular in females and patients reporting traumatic memories of the ICU.
创伤后应激已被确定为败血症后危重病幸存者的常见长期并发症。关于 ICU 住院后创伤后应激的长期轨迹和潜在可改变的危险因素知之甚少。研究目的是探讨和比较 ICU 出院后长达两年的败血症幸存者创伤后应激症状的不同临床轨迹。
在 ICU 出院后 1、6、12 和 24 个月时，通过创伤后症状量表（PTSS-10）收集创伤后应激症状的数据。ICU 前慢性精神科诊断的数据来自初级保健提供者的健康记录，而 ICU 文档中的 ICU 治疗数据。通过事后识别、变化模式区分和 k-均值聚类来确定创伤后症状的轨迹。在多项逻辑线性模型中预测轨迹的分配。
在 24 个月时，175 名患者完成了 PTSS-10 的所有随访测量。根据 PTSS 水平的临床轨迹，可以识别出三个聚类：稳定低症状（N=104 名患者[59%]）、症状增加（N=45 名患者[26%]）和症状恢复（N=26 名患者[15%]）。最初创伤后症状较高的患者更有可能出现下降（95%CI 的 OR：1.1 [1.05, 1.16]）。女性（OR=2.45 [1.11, 5.41]）和报告 ICU 早期创伤性记忆的患者（OR=4.04 [1.63, 10]）发生创伤后应激症状增加的风险更高。
创伤后应激是 ICU 后败血症患者的一个重要长期负担。在 ICU 出院后两年内确定了三种不同的轨迹，突出了长期观察的重要性，因为四分之一的患者在出院时报告症状较少，但在出院后两年内症状增加。即使在症状较少的患者中，尤其是在女性和报告 ICU 创伤性记忆的患者中，也应考虑对 ICU 幸存者进行创伤后应激的常规筛查。
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