重症监护后 1 年生活质量的变化：一项 ICU 幸存者的多中心前瞻性队列研究。
Changes in quality of life 1 year after intensive care: a multicenter prospective cohort of ICU survivors.
机构信息
Department of Intensive Care, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
Department of Intensive Care, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
出版信息
Crit Care. 2024 Jul 25;28(1):255. doi: 10.1186/s13054-024-05036-5.
BACKGROUND
With survival rates of critical illness increasing, quality of life measures are becoming an important outcome of ICU treatment. Therefore, to study the impact of critical illness on quality of life, we explored quality of life before and 1 year after ICU admission in different subgroups of ICU survivors.
METHODS
Data from an ongoing prospective multicenter cohort study, the MONITOR-IC, were used. Patients admitted to the ICU in one of eleven participating hospitals between July 2016 and June 2021 were included. Outcome was defined as change in quality of life, measured using the EuroQol five-dimensional (EQ-5D-5L) questionnaire, and calculated by subtracting the EQ-5D-5L score 1 day before hospital admission from the EQ-5D-5L score 1 year post-ICU. Based on the minimal clinically important difference, a change in quality of life was defined as a change in EQ-5D-5L score of ≥ 0.08. Subgroups of patients were based on admission diagnosis.
RESULTS
A total of 3913 (50.6%) included patients completed both baseline and follow-up questionnaires. 1 year post-ICU, patients admitted after a cerebrovascular accident, intracerebral hemorrhage, or (neuro)trauma, on average experienced a significant decrease in quality of life. Conversely, 11 other subgroups of ICU survivors reported improvements in quality of life. The largest average increase in quality of life was seen in patients admitted due to respiratory disease (mean 0.17, SD 0.38), whereas the largest average decrease was observed in trauma patients (mean -0.13, SD 0.28). However, in each of the studied 22 subgroups there were survivors who reported a significant increase in QoL and survivors who reported a significant decrease in QoL.
CONCLUSIONS
This large prospective multicenter cohort study demonstrated the diversity in long-term quality of life between, and even within, subgroups of ICU survivors. These findings emphasize the need for personalized information and post-ICU care.
TRIAL REGISTRATION
The MONITOR-IC study was registered at ClinicalTrials.gov: NCT03246334 on August 2nd 2017.
背景
随着危重病存活率的提高，生活质量衡量标准正成为 ICU 治疗的重要结果。因此，为了研究危重病对生活质量的影响，我们在不同的 ICU 幸存者亚组中探讨了 ICU 入院前后 1 年的生活质量。
方法
使用正在进行的前瞻性多中心队列研究 MONITOR-IC 的数据。该研究纳入了 2016 年 7 月至 2021 年 6 月期间在 11 家参与医院中入住 ICU 的患者。主要结局为使用 EuroQol 五维（EQ-5D-5L）问卷衡量的生活质量变化，通过减去入院前 1 天的 EQ-5D-5L 评分与 ICU 后 1 年的 EQ-5D-5L 评分来计算。根据最小临床重要差异，将生活质量变化定义为 EQ-5D-5L 评分变化≥0.08。根据入院诊断将患者分为不同亚组。
结果
共纳入 3913 例（50.6%）患者完成了基线和随访问卷。在 ICU 入住 1 年后，因脑血管意外、脑出血或（神经）创伤而入院的患者平均生活质量显著下降。相反，11 个其他 ICU 幸存者亚组报告生活质量得到改善。呼吸疾病患者的生活质量平均提高幅度最大（平均提高 0.17，标准差 0.38），而创伤患者的生活质量平均下降幅度最大（平均降低 0.13，标准差 0.28）。然而，在研究的 22 个亚组中，每个亚组都有报告生活质量显著提高的幸存者和报告生活质量显著降低的幸存者。
结论
这项大型前瞻性多中心队列研究表明，ICU 幸存者之间，甚至在幸存者的亚组内，长期生活质量存在差异。这些发现强调了个性化信息和 ICU 后护理的必要性。
试验注册
MONITOR-IC 研究于 2017 年 8 月 2 日在 ClinicalTrials.gov 注册：NCT03246334。
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