Short T G, Buckley T A, Rowbottom M Y, Wong E, Oh T E
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin.
Crit Care Med. 1999 Jan;27(1):51-7. doi: 10.1097/00003246-199901000-00026.
To assess mortality and functional health status of patients at 1 yr following admission to a multidisciplinary intensive care unit (ICU) in Hong Kong. To determine which factors are associated with a poor long-term outcome.
Prospective data collection and review.
A 14-bed multidisciplinary ICU in a 1,400-bed tertiary care university hospital.
Data from 2,268 consecutive patients admitted over a 2.5-yr period was analyzed, including follow-up at 1 yr in 853 adult survivors.
None.
The patients' clinical details and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded on day 2 of admission and reviewed at time of discharge or death. The mean APACHE II score on admission was 18. Survival status at 1 yr was ascertained and the sickness impact profile (SIP) scored as a measure of functional health status for survivors. Sixty-five percent of patients survived to discharge from hospital and 44% of patients were known to survive to 1 yr; 6% of patients could not be traced at 1 yr. Functional health status was assessed in 85% of eligible adult patients. Survivors to 1 yr were younger than nonsurvivors and had lower APACHE II scores. The median SIP score was 5.1, (25th and 75th percentiles: 0 to 15), and 76% of patients had SIP scores < or = 15, i.e., normal health to moderate disability. Five percent of the patients were not working or had retired for health-related reasons. Stepwise logistic regression to identify factors associated with poor functional health status defined as a SIP score >15 at 1 yr found increasing age, cardiac/ respiratory arrest, intracranial hemorrhage, and trauma to be associated with poor outcomes. A correlation was found between APACHE II scores and SIP scores (Spearman's correlation coefficient = 0.13, p < .001).
The SIP scores indicated that the majority of patients who survived to 1 yr after ICU admission enjoyed reasonable functional health status. A poor functional health status at 1 yr did not relate to the severity of the acute illness suffered, but appeared to relate to the prognosis of the underlying disease process.
评估香港一家多学科重症监护病房（ICU）收治患者入院1年后的死亡率和功能健康状况。确定哪些因素与不良的长期预后相关。
前瞻性数据收集与回顾。
一所拥有1400张床位的三级护理大学医院中的一间设有14张床位的多学科ICU。
分析了2.5年期间连续收治入院的2268例患者的数据，包括853例成年幸存者的1年随访情况。
无。
在入院第2天记录患者的临床详细信息和急性生理与慢性健康状况评估（APACHE）II评分，并在出院或死亡时进行复查。入院时APACHE II评分的平均值为18分。确定了1年时的生存状况，并对幸存者的疾病影响概况（SIP）进行评分，作为功能健康状况的一项指标。65%的患者存活至出院，已知44%的患者存活至1年；6%的患者在1年时无法追踪到。85%符合条件的成年患者接受了功能健康状况评估。存活至1年的患者比未存活者更年轻，APACHE II评分更低。SIP评分中位数为5.1（第25和第75百分位数：0至15），76%的患者SIP评分≤15，即健康状况正常至中度残疾。5%的患者因健康相关原因未工作或已退休。采用逐步逻辑回归分析确定与1年时功能健康状况不佳（定义为SIP评分>15）相关的因素，发现年龄增加、心脏/呼吸骤停、颅内出血和创伤与不良预后相关。APACHE II评分与SIP评分之间存在相关性（Spearman相关系数=0.13，p<0.001）。
SIP评分表明，大多数ICU入院后存活至1年的患者功能健康状况良好。1年时功能健康状况不佳与所患急性疾病的严重程度无关，而似乎与基础疾病进程的预后有关。
