Saltnes-Lillegård Christin, Rustøen Tone, Beitland Sigrid, Puntillo Kathleen, Hagen Milada, Hofsø Kristin
Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Blindern, 0316, Oslo, Norway.
Intensive Care Med. 2025 Jun 30. doi: 10.1007/s00134-025-07995-x.
The aim was to identify possible associations between patient symptom subgroups, identified while in the ICU, adjusted for clinical and demographic variables and PICS outcomes, three months after ICU admission.
A prospective multi-center cohort study. Based on reported symptom prevalence in the ICU, patients were categorized into a Low, Middle or High symptom subgroup. PICS outcomes were measured using validated questionnaires (i.e., Katz Index; Cognitive Failure questionnaire, The Hospital Anxiety and Depression Scale, Impact of Event Scale) three months after ICU admission. Possible associations between ICU symptom subgroups and dichotomized PICS outcomes were modeled using conditional backward logistic regression.
We included 175 patients with a median age of 62 years (interquartile range 49-70) and 65.1% were males. Three months after ICU admission, 23.5% had physical disability, 12.1% cognitive failure, 18.3% anxiety, 16.6% depression, and 16.7% post-traumatic stress. In multivariate analyses, patients in the High symptom subgroup compared to Low/Middle symptom subgroups had higher odds for worse outcomes in all PICS domains. The odds ratios (95%CI) were 3.31 (1.25-8.78) for physical disability, 3.56 (1.20-10.60) for cognitive failure, 3.70 (1.41-9.67) for anxiety, 4.74 (1.79-12.58) for depression and 4.38 (1.49-12.84) for post-traumatic stress, respectively.
A subgroup of patients with high symptom burden during ICU stay had worse physical, cognitive and mental health outcomes three months after ICU admission compared to patients with medium/low symptom burden. Future studies are needed to evaluate if early interventions in the ICU can reduce long-time burden in the PICS domains in ICU survivors.
旨在确定入住重症监护病房（ICU）期间识别出的患者症状亚组之间可能存在的关联，并对临床和人口统计学变量以及ICU入院三个月后的重症监护后综合征（PICS）结局进行调整。
一项前瞻性多中心队列研究。根据ICU中报告的症状患病率，将患者分为低、中或高症状亚组。在ICU入院三个月后，使用经过验证的问卷（即 Katz 指数、认知功能障碍问卷、医院焦虑抑郁量表、事件影响量表）测量PICS结局。使用条件向后逻辑回归对ICU症状亚组与二分法PICS结局之间可能存在的关联进行建模。
我们纳入了175例患者，中位年龄为62岁（四分位间距49 - 70岁），65.1%为男性。ICU入院三个月后，23.5%的患者存在身体残疾，12.1%存在认知功能障碍，18.3%存在焦虑，16.6%存在抑郁，16.7%存在创伤后应激障碍。在多变量分析中，与低/中症状亚组相比，高症状亚组的患者在所有PICS领域出现较差结局的几率更高。身体残疾的比值比（95%置信区间）为3.31（1.25 - 8.78），认知功能障碍为3.56（1.20 - 10.60），焦虑为3.70（1.41 - 9.67），抑郁为4.74（1.79 - 12.58），创伤后应激障碍为4.38（1.49 - 12.84）。
与症状负担中等/较低的患者相比，在ICU住院期间症状负担高的患者亚组在ICU入院三个月后身体、认知和心理健康结局更差。未来需要进行研究，以评估在ICU中进行早期干预是否可以减轻ICU幸存者在PICS领域的长期负担。
