晚期慢性或持续性传染病患者的高症状负担：不止是疼痛。
High Symptom Burden in Patients With Advanced Chronic or Prolonged Infectious Diseases: Not Only Pain.
作者信息
Angeli Elena, Zambelli Agostino, Corli Oscar, Bestetti Giovanna, Landonio Simona, Merli Stefania, Cheli Stefania, Rizzardini Giuliano
机构信息
Infectious Diseases Department, Fatebenefratelli-Sacco University Hospital, Milan, ITA.
Pain Therapy and Palliative Care Unit, Institute for Pharmacological Research Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, ITA.
出版信息
Cureus. 2024 Oct 18;16(10):e71751. doi: 10.7759/cureus.71751. eCollection 2024 Oct.
INTRODUCTION
The growing evidence of increased life expectancy in the future reveals the high relevance of frailty in patients with chronic-degenerative diseases; identification and management of symptoms may improve significantly their quality of life. The objective of our study was to assess the symptom burden in patients with advanced chronic or prolonged infectious diseases.
MATERIALS AND METHODS
A cross-sectional study was performed enrolling 88 patients, referred to palliative care consultation for chronic pain, and evaluated using the Edmonton Symptom Assessment System to define Total Symptom Distress Score (TSDS) and high symptom burden (HSB) when more than six symptoms along with Numerical Rating Scale ≥4 were present.
RESULTS
All participants reported moderate to severe pain; in addition, 86 (97.7%) experienced a lack of well-being, 81 (92%) tiredness, 67 (76.1%) lack of appetite, 66 (75%) drowsiness, 66 (75%) depression, 56 (63.6%) anxiety, 49 (55.6%) nausea, and 39 (44.3%) shortness of breath. Forty-four patients (50%) had high TSDS, greater than 40.5, and presented lower Karnofsky Performance Scale (KPS) (median 40 vs. 70, p=0.0005), higher comorbidities (median 7 vs. 4, p=0.00001), and higher drug burden (median 9 vs. 6, p=0.0003) than those with low TSDS. Furthermore, considering symptom intensity, 40 patients (45.4%) had HSB and presented lower KPS (median 50 vs. 70, p=0.0005), higher comorbidities (median 7 vs. 4, p=0.00001), and higher drug burden (mean 9 vs. 6, p=0.01) compared to patients without HSB.
CONCLUSION
Our population had an HSB, in addition to pain, revealing high frailty. A correct assessment of symptoms is, therefore, required to manage patients with chronic infectious diseases. In this setting, attention should be given to identifying patients at high risk of HSB through a correct diagnosis and effective management, which should be based on a multi-professional approach.
引言
未来预期寿命增加的证据越来越多，这表明虚弱在慢性退行性疾病患者中具有高度相关性；症状的识别和管理可能会显著提高他们的生活质量。我们研究的目的是评估晚期慢性或长期感染性疾病患者的症状负担。
材料与方法
进行了一项横断面研究，纳入了88例因慢性疼痛转诊至姑息治疗咨询门诊的患者，并使用埃德蒙顿症状评估系统进行评估，以确定总症状困扰评分（TSDS）以及当出现六种以上症状且数字评分量表≥4分时的高症状负担（HSB）。
结果
所有参与者均报告有中度至重度疼痛；此外，86例（97.7%）感到不适，81例（92%）感到疲倦，67例（76.1%）食欲不振，66例（75%）嗜睡，66例（75%）抑郁，56例（63.6%）焦虑，49例（55.6%）恶心，39例（44.3%）呼吸急促。44例患者（50%）的TSDS较高，大于40.5，与TSDS较低的患者相比，其卡氏功能状态评分（KPS）较低（中位数40对70，p = 0.0005），合并症更多（中位数7对4，p = 0.00001），药物负担更高（中位数9对6，p = 0.0003）。此外，考虑症状强度，40例患者（45.4%）有HSB，与无HSB的患者相比，其KPS较低（中位数50对70，p = 0.0005），合并症更多（中位数7对4，p = 0.00001），药物负担更高（平均值9对6，p = 0.01）。
结论
我们的研究人群除疼痛外还存在高症状负担，显示出高度虚弱。因此，对于慢性感染性疾病患者的管理需要正确评估症状。在这种情况下，应通过正确诊断和有效管理，关注识别高HSB风险患者，这应基于多专业方法。
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