Association of Lack of Fear of Dying With New Organ Failure: Results of a Multicenter Prospective Cohort Study.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE American Journal of Critical Care Pub Date : 2024-01-01 DOI:10.4037/ajcc2024517

Aurélien Mazeraud, Guillaume Turc, Sivanthiny Sivanandamoorthy, Raphaël Porcher, Annabelle Stoclin, Marion Antona, Andrea Polito, Cassia Righy, Fernando A B Bozza, Shidasp Siami, Tarek Sharshar

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Abstract

Background: Patients' anxiety on intensive care unit (ICU) admission is associated with subsequent deterioration.

Objective: To assess whether patients' fears/anxiety are predictive of new organ failure within 7 days of ICU admission.

Methods: In a prospective 3-center cohort study of non-comatose patients without delirium or invasive mechanical ventilation, 9 specific fears were evaluated through yes/no questions. Illness severity was assessed using the Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA). Intensity of acute and chronic anxiety was assessed with the state and trait components of the State-Trait Anxiety Inventory (STAI). Patients were followed up for 7 days.

Results: From April 2014 to December 2017, 373 patients (median [IQR] age, 63 [48-74] years; 152 [40.8%] women; median (IQR) SAPS II, 27 [19-37]) were included. Feelings of vulnerability and fear of dying were reported by 203 (54.4%) and 172 (46.1%) patients, respectively. The STAI-State score was 40 or greater in 192 patients (51.5%). Ninety-four patients (25.2%) had new organ failure. Feelings of vulnerability (odds ratio, 1.96 [95% CI, 1.12-3.43]; P=.02) and absence of fear of dying (odds ratio, 2.38 [95% CI, 1.37-4.17]; P=.002) were associated with new organ failure after adjustment for STAI-State score (≥40), SAPS II, and SOFA score.

Conclusion: Absence of fear of dying is associated with new organ failure within the first 7 days after ICU admission. Fear of dying may protect against subsequent deterioration by mobilizing patients' homeostatic resources. ClinicalTrials.gov Identifier: NCT02355626.

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缺乏对死亡的恐惧与新器官衰竭的关系：一项多中心前瞻性队列研究的结果

背景：重症监护病房（ICU）患者入院时的焦虑与随后病情的恶化有关：重症监护病房（ICU）患者入院时的焦虑与随后的病情恶化有关：目的：评估患者的恐惧/焦虑是否可预测入住重症监护室 7 天内新出现的器官衰竭：在一项针对无谵妄或侵入性机械通气的非昏迷患者的前瞻性 3 中心队列研究中，通过是/否问题评估了 9 种特定的恐惧。病情严重程度采用简化急性生理学评分 II（SAPS II）和序贯器官衰竭评估（SOFA）进行评估。急性和慢性焦虑的强度通过状态-特质焦虑量表（STAI）的状态和特质部分进行评估。对患者进行了为期7天的随访：从2014年4月至2017年12月，共纳入了373名患者（中位数[IQR]年龄，63[48-74]岁；女性152[40.8%]；中位数（IQR）SAPS II，27[19-37]）。分别有 203 名（54.4%）和 172 名（46.1%）患者报告了脆弱感和死亡恐惧感。192名患者（51.5%）的STAI-State评分达到或超过40分。94名患者（25.2%）出现了新的器官衰竭。在调整 STAI-State 评分（≥40 分）、SAPS II 和 SOFA 评分后，脆弱感（几率比 1.96 [95% CI, 1.12-3.43]；P=.02）和不惧怕死亡（几率比 2.38 [95% CI, 1.37-4.17]；P=.002）与新的器官衰竭相关：结论：缺乏对死亡的恐惧与入住 ICU 后头 7 天内新出现的器官功能衰竭有关。对死亡的恐惧可通过调动患者的体内平衡资源来防止病情恶化。ClinicalTrials.gov Identifier：NCT02355626。

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来源期刊

American Journal of Critical Care 医学-护理

CiteScore

4.30

自引率

3.70%

发文量

103

审稿时长

6-12 weeks

期刊介绍： The editors of the American Journal of Critical Care (AJCC) invite authors to submit original manuscripts describing investigations, advances, or observations from all specialties related to the care of critically and acutely ill patients. Papers promoting collaborative practice and research are encouraged. Manuscripts will be considered on the understanding that they have not been published elsewhere and have been submitted solely to AJCC.

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