Wu A W, Damiano A M, Lynn J, Alzola C, Teno J, Landefeld C S, Desbiens N, Tsevat J, Mayer-Oakes A, Harrell F E, Knaus W A
Health Services Research and Development Center, Johns Hopkins University, Baltimore, MD 21205-1901.
Ann Intern Med. 1995 Mar 1;122(5):342-50. doi: 10.7326/0003-4819-122-5-199503010-00004.
To develop a model estimating the probability of an adult patient having severe functional limitations 2 months after being hospitalized with one of nine serious illnesses.
Prospective cohort study.
Five teaching hospitals in the United States.
1746 patients (model development) who survived 2 months and completed an interview, selected from 4301 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT); independent validation sample of 2478 patients.
Patient function 2 months after admission categorized as absence or presence of severe functional limitations (defined as Sickness Impact Profile scores > or = 30 or as activities of daily living scores > or = 4 [levels that require near-constant personal assistance]). A logistic regression model was constructed to predict severe functional limitation.
One third (n = 590) of patients who were interviewed at 2 months had severe functional limitations. Changes in functional status were common: Of those with no baseline dependencies (not dependent on personal assistance), 21% were severely limited at 2 months; of those with 4 or more baseline limitations, 30% had improved. The patient's ability to do activities of daily living was the most important predictor of functional status. Physiologic abnormalities, diagnosis, days in hospital, age, quality of life, and previous exercise capacity also contributed substantially. Model performance, assessed using receiver-operating characteristic curves, was 0.79 for the development sample and 0.75 for the validation sample. The model was well calibrated for the entire risk range.
Functional outcome varied substantially after hospitalization for a serious illness. A small amount of readily available clinical information can estimate the probability of severe functional limitations.
建立一个模型，用于估计成年患者因九种严重疾病之一住院两个月后出现严重功能受限的概率。
前瞻性队列研究。
美国的五家教学医院。
从“了解治疗结果和风险的预后及偏好研究”（SUPPORT）中的4301名患者中选出1746名存活2个月并完成访谈的患者（用于模型开发）；2478名患者的独立验证样本。
入院两个月后的患者功能分为有无严重功能受限（定义为疾病影响剖面图得分≥30或日常生活活动得分≥4[需要近乎持续个人协助的水平]）。构建逻辑回归模型来预测严重功能受限。
在两个月时接受访谈的患者中有三分之一（n = 590）存在严重功能受限。功能状态变化很常见：在那些无基线依赖（不依赖个人协助）的患者中，21%在两个月时严重受限；在那些有4项或更多基线限制的患者中，30%有所改善。患者的日常生活活动能力是功能状态最重要的预测因素。生理异常、诊断、住院天数、年龄、生活质量和既往运动能力也有很大影响。使用受试者工作特征曲线评估，模型在开发样本中的表现为0.79，在验证样本中的表现为0.75。该模型在整个风险范围内校准良好。
因重病住院后的功能结局差异很大。少量易于获得的临床信息可估计严重功能受限的概率。
