老年脓毒症患者出院后的功能结局。

Post-discharge functional outcomes in older patients with sepsis.

机构信息

Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan.

Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

出版信息

Crit Care. 2024 Aug 29;28(1):281. doi: 10.1186/s13054-024-05080-1.

DOI:10.1186/s13054-024-05080-1

PMID:39210369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11363546/

Abstract

BACKGROUND

The post-discharge prognosis of patients with sepsis remains a crucial issue; however, few studies have investigated the relationship between pre-sepsis health status and subsequent prognosis in a large population. This study aimed to examine the effect of the pre-sepsis care needs level on changes in care needs and mortality in patients with sepsis 1 year post-discharge.

METHODS

This was a population-based retrospective cohort study including twelve municipalities in Japan that participated in the Longevity Improvement & Fair Evidence study between April 2014 and March 2022, with a total of 1,491,608 persons. The pre-hospitalization levels of care needs (baseline) were classified from low to high, as no care needs, support level and care needs level 1, care needs levels 2-3, and care needs levels 4-5 (fully dependent). The outcomes were changes in care needs level and mortality 1 year post-discharge, assessed by baseline care needs level using Cox proportional hazard models.

RESULTS

The care needs levels of 17,648 patients analyzed at baseline were as follows: no care needs, 7982 (45.2%); support level and care needs level 1, 3736 (21.2%); care needs levels 2-3, 3089 (17.5%); and care needs levels 4-5, 2841 (16.1%). At 1 year post-discharge, the distribution of care needs were as follows: no care needs, 4791 (27.1%); support level and care needs level 1, 2390 (13.5%); care needs levels 2-3, 2629 (14.9%); care needs levels 4-5, 3373 (19.1%); and death, 4465 (25.3%). Patients with higher levels of care needs exhibited an increased association of all-cause mortality 1 year post-discharge after adjusting for confounders [hazard ratios and 95% confidence intervals: support level and care needs level 1, 1.05 (0.96, 1.15); care needs levels 2-3, 1.46 (1.33, 1.60); and care needs levels 4-5, 1.92 (1.75, 2.10); P for trend < 0.001].

CONCLUSIONS

Elevated care needs and mortality were observed in patients with sepsis within 1 year post-discharge. Older patients with sepsis and higher baseline levels of care needs had a high association of all-cause mortality 1 year post-discharge.

摘要

背景

脓毒症患者出院后的预后仍然是一个关键问题；然而，很少有研究在大人群中调查脓毒症前健康状况与随后预后之间的关系。本研究旨在探讨脓毒症患者出院后 1 年时，脓毒症前护理需求水平对护理需求变化和死亡率的影响。

方法

这是一项基于人群的回顾性队列研究，包括日本的 12 个市，这些市参加了 2014 年 4 月至 2022 年 3 月期间的长寿改善和公平证据研究，共有 1491608 人。在入院前，通过 Cox 比例风险模型，根据基线护理需求水平，将护理需求水平（基线）从低到高分为无护理需求、支持水平和护理需求水平 1、护理需求水平 2-3 和护理需求水平 4-5（完全依赖）。使用 Cox 比例风险模型，根据基线护理需求水平评估出院后 1 年时的护理需求水平变化和死亡率。

结果

分析了 17648 名患者在基线时的护理需求水平如下：无护理需求 7982（45.2%）；支持水平和护理需求水平 1 3736（21.2%）；护理需求水平 2-3 3089（17.5%）；护理需求水平 4-5 2841（16.1%）。出院后 1 年时的护理需求分布如下：无护理需求 4791（27.1%）；支持水平和护理需求水平 1 2390（13.5%）；护理需求水平 2-3 2629（14.9%）；护理需求水平 4-5 3373（19.1%）；死亡 4465（25.3%）。调整混杂因素后，所有原因死亡率与护理需求水平呈正相关[危险比和 95%置信区间：支持水平和护理需求水平 1，1.05（0.96，1.15）；护理需求水平 2-3，1.46（1.33，1.60）；护理需求水平 4-5，1.92（1.75，2.10）；趋势 P<0.001]。